Effect of Intravenous High Dose Vitamin C on Postoperative Pain and Morphine Use after Laparoscopic Colectomy: A Randomized Controlled Trial

Abstract

Background and Objective. Vitamin C has antioxidant, neuroprotective, and neuromodulating effects. Recently, it showed antinociceptive effect as a result of the antioxidant properties. Therefore, we designed this study to assess the effect of intravenous vitamin C on opiate consumption and pain in patients undergoing laparoscopic colectomy. Methods. A total of 100 patients were enrolled and allocated to receive 50 mg/kg vitamin C or placebo by intravenous infusion immediately after induction of anesthesia. Morphine consumption and scores of pain were assessed at 2, 6, and 24 h after completion of surgery. Results. There were 97 patients included in the analysis. Patients who received vitamin C had higher plasma concentrations of vitamin C at the end of surgery, significantly lower morphine consumption at the 2 h after end of surgery, and significantly lower pain scores at rest during first 24 h postoperatively. There was no significant difference between groups in side effects, fatigue score, or pain score during cough. Conclusion. This study shows high dose vitamin C infusion decreased postoperative pain during the first 24 h and reduced morphine consumption in the early postoperative period. Additional research needed to examine whether higher doses of vitamin C and longer infusion times can amplify these effects.

The efficacy of vitamin C infusion in reducing post-intubation sore throat

“…Recent studies have shown that vitamin C may be effective in reducing post-operative pain especially in chronic and acute pain following orthopedic surgeries (30). Jeon et al, also confirmed a previous study and reported that vitamin C might be a beneficial adjunct for management of pain without main side effects (28). Carr et al, also demonstrated the effect of vitamin C on the incidence of complex regional pain syndrome in ankle and wrist surgery (34).…”

“…Administration of vitamin C infusion in patients undergoing laparoscopic surgery showed that sore throat and score pain decreased compared to the control group. Vitamin C has a neuromodulating action (38), particularly dopamine and glutamate mediated neurotransmission (28). Laparoscopic colectomy leads to oxidative stress and ROS formation which contributes to abdominal inflation/deflation.…”

“…On the other hand, pharmacological and non-pharmacological procedures are used for the elimination of sore throat (27). Therefore, decreasing and minimizing postoperative sore throat is the main goal (28).…”

“…Modern and new anaesthesia practices and improved airway tools have decreased these complications (25). Opioids as the most widely used class of analgesics have been used in management of postoperative pain, but they may increase the risk of nausea and vomiting and postpone postsurgical recovery of gastrointestinal mobility (28). New, non-opioid analgesic alternatives have been recommended for decreasing pain and restricting opioid-related side effects (29).…”

“…Diseases such as surgery and trauma lead to depletion of vitamin C in body (36). Infection, sepsis (37), cancer and colon surgery (28) are other diseases which are associated with vitamin C deficiency. Recent studies have shown that vitamin C may be effective in reducing post-operative pain especially in chronic and acute pain following orthopedic surgeries (30).…”