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

Younghoon Jeon, Jun Seok Park, Suyoung Moon, Jinseok Yeo, Younghoon Jeon, Jun Seok Park, Suyoung Moon, Jinseok Yeo

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.

Figures

Figure 1
Figure 1
Flow chart describing recruitment, allocation, follow-up, and analysis. NRS, numeric rating scale.
Figure 2
Figure 2
Pain scores at rest (a) and during coughing (b) by numeric rating scale at 2, 6, and 24 h after surgery (mean ± standard deviation). ∗P < 0.05.
Figure 3
Figure 3
Postoperative morphine consumption (a) at 2, 6, and 24 h after surgery and numeric rating scores of fatigue (b) before surgery and at 2, 6, and 24 h after surgery. Data are shown as means ± standard deviation. ∗P < 0.05.

References

    1. Zengin S. U., Saracoglu A., Eti Z., Umuroglu T., Gogus F. Y. The effects of preoperative oral pregabalin and perioperative intravenous lidocaine infusion on postoperative morphine requirement in patients undergoing laparatomy. Pain Research and Management. 2015;20(4):179–182. doi: 10.1155/2015/509474.
    1. Jones O. M., Lindsey I., Cunningham C. Laparoscopic colorectal surgery. BMJ. 2011;343 doi: 10.1136/bmj.d8029.d8029
    1. Breivik H. Postoperative pain management: why is it difficult to show that it improves outcome? European Journal of Anaesthesiology. 1998;15(6):748–751. doi: 10.1097/00003643-199811000-00022.
    1. Kehlet H., Dahl J. B. Anaesthesia, surgery, and challenges in postoperative recovery. The Lancet. 2003;362(9399):1921–1928. doi: 10.1016/s0140-6736(03)14966-5.
    1. Dorota Majewska M., Bell J. A. Ascorbic acid protects neurons from injury induced by glutamate and NMDA. NeuroReport. 1990;1(3):194–196. doi: 10.1097/00001756-199011000-00004.
    1. Majewska M. D., Bell J. A., London E. D. Regulation of the NMDA receptor by redox phenomena: inhibitory role of ascorbate. Brain Research. 1990;537(1-2):328–332. doi: 10.1016/0006-8993(90)90379-p.
    1. Besse J.-L., Gadeyne S., Galand-Desmé S., Lerat J.-L., Moyen B. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. Foot and Ankle Surgery. 2009;15(4):179–182. doi: 10.1016/j.fas.2009.02.002.
    1. Chen J.-Y., Chang C.-Y., Feng P.-H., Chu C.-C., So E. C., Hu M.-L. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain. Clinical Journal of Pain. 2009;25(7):562–569. doi: 10.1097/AJP.0b013e318193cf32.
    1. Hasanzadeh K. F., Soleimani A., Habibi M. R., Emami Z. A. Can vitamin C be used as an adjuvant for managing postoperative pain? A short literature review. Korean Journal of Pain. 2013;26:209–210.
    1. Park I. J., Choi G.-S., Lim K.-H., Kang B.-M., Jun S.-H. Laparoscopic resection of extraperitoneal rectal cancer: a comparative analysis with open resection. Surgical Endoscopy and Other Interventional Techniques. 2009;23(8):1818–1824. doi: 10.1007/s00464-008-0265-6.
    1. Berger M. M. Vitamin C requirements in parenteral nutrition. Gastroenterology. 2009;137(5, supplement):S70–S78. doi: 10.1053/j.gastro.2009.08.012.
    1. Kim H. K., Park S. K., Zhou J.-L., et al. Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain. Pain. 2004;111(1-2):116–124. doi: 10.1016/j.pain.2004.06.008.
    1. Rokyta R., Holecek V., Pekárková I., et al. Free radicals after painful stimulation are influenced by antioxidants and analgesics. Neuroendocrinology Letters. 2003;24(5):304–309.
    1. Rebec G. V., Pierce R. C. A vitamin as neuromodulator: ascorbate release into the extracellular fluid of the brain regulates dopaminergic and glutamatergic transmission. Progress in Neurobiology. 1994;43(6):537–565. doi: 10.1016/0301-0082(94)90052-3.
    1. Grünewald R. A. Ascorbic acid in the brain. Brain Research Reviews. 1993;18(1):123–133. doi: 10.1016/0165-0173(93)90010-W.
    1. Rosa K. A., Gadotti V. M., Rosa A. O., Rodrigues A. L. S., Calixto J. B., Santos A. R. S. Evidence for the involvement of glutamatergic system in the antinociceptive effect of ascorbic acid. Neuroscience Letters. 2005;381(1-2):185–188. doi: 10.1016/j.neulet.2005.02.032.
    1. Harrison F. E., Yu S. S., Van Den Bossche K. L., Li L., May J. M., McDonald M. P. Elevated oxidative stress and sensorimotor deficits but normal cognition in mice that cannot synthesize ascorbic acid. Journal of Neurochemistry. 2008;106(3):1198–1208. doi: 10.1111/j.1471-4159.2008.05469.x.
    1. Rice M. E. Ascorbate regulation and its neuroprotective role in the brain. Trends in Neurosciences. 2000;23(5):209–216. doi: 10.1016/S0166-2236(99)01543-X.
    1. Willis W. D., Westlund K. N. Neuroanatomy of the pain system and of the pathways that modulate pain. Journal of Clinical Neurophysiology. 1997;14(1):2–31. doi: 10.1097/00004691-199701000-00002.
    1. Mayland C. R., Bennett M. I., Allan K. Vitamin C deficiency in cancer patients. Palliative Medicine. 2005;19(1):17–20. doi: 10.1191/0269216305pm970oa.
    1. Sare M., Yilmaz I., Hamamci D., Birincioglu M., Özmen M., Yesilada Ö. The effect of carbon dioxide pneumoperitoneum on free radicals. Surgical Endoscopy. 2000;14(7):649–652. doi: 10.1007/s004640000168.
    1. Pappas-Gogos G., Tellis C., Lasithiotakis K., et al. Oxidative stress markers in laparoscopic versus open colectomy for cancer: a double-blind randomized study. Surgical Endoscopy and Other Interventional Techniques. 2013;27(7):2357–2365. doi: 10.1007/s00464-013-2788-8.
    1. Fukushima R., Yamazaki E. Vitamin C requirement in surgical patients. Current Opinion in Clinical Nutrition & Metabolic Care. 2010;13(6):669–676.
    1. Nielsen T. K., Højgaard M., Andersen J. T., Poulsen H. E., Lykkesfeldt J., Mikines K. J. Elimination of ascorbic acid after high-dose infusion in prostate cancer patients: a pharmacokinetic evaluation. Basic and Clinical Pharmacology and Toxicology. 2003;116(4):343–348. doi: 10.1111/bcpt.12323.
    1. Suh S.-Y., Bae W., Ahn H.-Y., Choi S.-E., Jung G.-C., Yeom C. Intravenous vitamin C administration reduces fatigue in office workers: a double-blind randomized controlled trial. Nutrition Journal. 2012;11(1, article 7) doi: 10.1186/1475-2891-11-7.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel