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Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 6/2012

01.06.2012 | Reports of Original Investigations

Effect of vitamin C on morphine use after laparoscopic cholecystectomy: a randomized controlled trial

verfasst von: Ghassan E. Kanazi, MD, Mohammad F. El-Khatib, PhD, Vanda G. Yazbeck- Karam, MD, Janane E. Hanna, MSN, Badiaa Masri, MPH, Marie T. Aouad, MD

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 6/2012

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Abstract

Purpose

We designed a randomized double-blind placebo-controlled trial to assess the role of a single prophylactic dose of vitamin C (2 g) po in reducing the consumption of opioids postoperatively in patients undergoing laparoscopic cholecystectomy.

Methods

Eighty adult patients were allocated to receive 2 g vitamin C po or placebo approximately one hour prior to induction of anesthesia. Following laparoscopic cholecystectomy, patients received morphine patient-controlled analgesia for 24 hr. The following data were assessed postoperatively in the postanesthesia care unit at two, four, six, 12, and 24 hr: morphine consumption, verbal numerical rating scale scores for incisional pain and nausea/vomiting, and pruritus and sedation scores. The primary outcome measure was 24-hr morphine consumption. Patient satisfaction was assessed before hospital discharge.

Results

Morphine consumption was significantly lower in the vitamin C group vs the placebo group [16.2 (10.7) and 22.8 (13.8) mg, respectively; difference = 6.6 mg; 95% confidence interval, 1.1 to 12.1 mg; P = 0.02]. There was no difference in pain scores or side effects between the two groups. Satisfaction scores were similar in both groups.

Conclusion

Our study showed that supplementation with vitamin C (2 g) po decreased morphine consumption in the postoperative period in patients undergoing laparoscopic cholecystectomy. (ClinicalTrials.gov number, NCT01322061).
Literatur
1.
Zurück zum Zitat Bisgaard T. Anelgesic treatment after laparoscopic cholecystetcomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835-46.PubMedCrossRef Bisgaard T. Anelgesic treatment after laparoscopic cholecystetcomy: a critical assessment of the evidence. Anesthesiology 2006; 104: 835-46.PubMedCrossRef
2.
Zurück zum Zitat Chung F, Tong D, Miceli PC, et al. Controlled-release codeine is equivalent to acetaminophen plus codeine for post-cholecystectomy analgesia. Can J Anesth 2004; 51: 216-21.PubMedCrossRef Chung F, Tong D, Miceli PC, et al. Controlled-release codeine is equivalent to acetaminophen plus codeine for post-cholecystectomy analgesia. Can J Anesth 2004; 51: 216-21.PubMedCrossRef
3.
Zurück zum Zitat Rebec GV, Pierce RC. A vitamin as neuromodulator: ascorbate release into the extracellular fluid of the brain regulates dopaminergic and glutamatergic transmission. Prog Neurobiol 1994; 43: 537-65.PubMedCrossRef Rebec GV, Pierce RC. A vitamin as neuromodulator: ascorbate release into the extracellular fluid of the brain regulates dopaminergic and glutamatergic transmission. Prog Neurobiol 1994; 43: 537-65.PubMedCrossRef
4.
Zurück zum Zitat Alpsoy L, Yildirim A, Agar G. The antioxidant effects of vitamin A, C, and E on aflatoxin B1-induced oxidative stress in human lymphocytes. Toxicol Ind Health 2009; 25: 121-7.PubMedCrossRef Alpsoy L, Yildirim A, Agar G. The antioxidant effects of vitamin A, C, and E on aflatoxin B1-induced oxidative stress in human lymphocytes. Toxicol Ind Health 2009; 25: 121-7.PubMedCrossRef
5.
Zurück zum Zitat Kim HK, Park SK, Zhou JL, et al. Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain. Pain 2004; 111: 116-24.PubMedCrossRef Kim HK, Park SK, Zhou JL, et al. Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain. Pain 2004; 111: 116-24.PubMedCrossRef
6.
Zurück zum Zitat Majewska MD, Bell JA. Ascorbic acid protects neurons from injury induced by glutamate and NMDA. Neuroreport 1990; 1: 194-6.PubMedCrossRef Majewska MD, Bell JA. Ascorbic acid protects neurons from injury induced by glutamate and NMDA. Neuroreport 1990; 1: 194-6.PubMedCrossRef
7.
Zurück zum Zitat Majewska MD, Bell JA, London ED. Regulation of the NMDA receptor by redox phenomena: inhibitory role of ascorbate. Brain Res 1990; 537: 328-32.PubMedCrossRef Majewska MD, Bell JA, London ED. Regulation of the NMDA receptor by redox phenomena: inhibitory role of ascorbate. Brain Res 1990; 537: 328-32.PubMedCrossRef
8.
Zurück zum Zitat Jensen NH. Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over trial in general practice (Danish). Ugeskr Laeger 2003; 165: 2563-6.PubMed Jensen NH. Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over trial in general practice (Danish). Ugeskr Laeger 2003; 165: 2563-6.PubMed
9.
Zurück zum Zitat Besse JL, Gadeyne S, Galand-Desme S, Lerat JL, Moyen B. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. Foot Ankle Surg 2009; 15: 179-82.PubMedCrossRef Besse JL, Gadeyne S, Galand-Desme S, Lerat JL, Moyen B. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. Foot Ankle Surg 2009; 15: 179-82.PubMedCrossRef
10.
Zurück zum Zitat Chen JY, Chang CY, Feng PH, Chu CC, So EC, Hu ML. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin c reduces spontaneous pain but not brush-evoked pain. Clin J Pain 2009; 25: 562-9.PubMedCrossRef Chen JY, Chang CY, Feng PH, Chu CC, So EC, Hu ML. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin c reduces spontaneous pain but not brush-evoked pain. Clin J Pain 2009; 25: 562-9.PubMedCrossRef
11.
Zurück zum Zitat Kirk G, White J, McKie L, et al. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg 2006; 10: 499-503.PubMedCrossRef Kirk G, White J, McKie L, et al. Combined antioxidant therapy reduces pain and improves quality of life in chronic pancreatitis. J Gastrointest Surg 2006; 10: 499-503.PubMedCrossRef
12.
Zurück zum Zitat Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1988 . Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.; 1988 .
13.
Zurück zum Zitat Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; 27: S178-89.PubMedCrossRef Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care 1989; 27: S178-89.PubMedCrossRef
14.
Zurück zum Zitat Grant Knap R, Miller MC. Clinical Epidemiology and Biostatistics. The National Medical Series for Independent Study. National Medical Series. Baltimore, MD: Williams & Wilkins; 1992: 419 Grant Knap R, Miller MC. Clinical Epidemiology and Biostatistics. The National Medical Series for Independent Study. National Medical Series. Baltimore, MD: Williams & Wilkins; 1992: 419
15.
Zurück zum Zitat Rokyta R, Holecek V, Pekarkova I, et al. Free radicals after painful stimulation are influenced by antioxidants and analgesics. Neuro Endocrinol Lett 2003; 24: 304-9.PubMed Rokyta R, Holecek V, Pekarkova I, et al. Free radicals after painful stimulation are influenced by antioxidants and analgesics. Neuro Endocrinol Lett 2003; 24: 304-9.PubMed
16.
17.
Zurück zum Zitat Rosa KA, Gadotti VM, Rosa AO, Rodrigues AL, Calixto JB, Santos AR. Evidence for the involvement of glutamatergic system in the antinociceptive effect of ascorbic acid. Neurosci Lett 2005; 381: 185-8.PubMedCrossRef Rosa KA, Gadotti VM, Rosa AO, Rodrigues AL, Calixto JB, Santos AR. Evidence for the involvement of glutamatergic system in the antinociceptive effect of ascorbic acid. Neurosci Lett 2005; 381: 185-8.PubMedCrossRef
18.
Zurück zum Zitat Jones RB, Satterlee DG, Cadd GG. Timidity in Japanese quail: effects of vitamin C and divergent selection for adrenocortical response. Physiol Behav 1999; 67: 117-20.PubMedCrossRef Jones RB, Satterlee DG, Cadd GG. Timidity in Japanese quail: effects of vitamin C and divergent selection for adrenocortical response. Physiol Behav 1999; 67: 117-20.PubMedCrossRef
19.
Zurück zum Zitat Harrison FE, Yu SS, Van Den Bossche KL, Li L, May JM, McDonald MP. Elevated oxidative stress and sensorimotor deficits but normal cognition in mice that cannot synthesize ascorbic acid. J Neurochem 2008; 106: 1198-208.PubMedCrossRef Harrison FE, Yu SS, Van Den Bossche KL, Li L, May JM, McDonald MP. Elevated oxidative stress and sensorimotor deficits but normal cognition in mice that cannot synthesize ascorbic acid. J Neurochem 2008; 106: 1198-208.PubMedCrossRef
20.
Zurück zum Zitat Rice ME. Ascorbate regulation and its neuroprotective role in the brain. Trends Neurosci 2000; 23: 209-16.PubMedCrossRef Rice ME. Ascorbate regulation and its neuroprotective role in the brain. Trends Neurosci 2000; 23: 209-16.PubMedCrossRef
21.
Zurück zum Zitat Kuo CH, Yonehara N, Hata F, Yoshida H. Subcellular distribution of ascorbic acid in rat brain. Jpn J Pharmacol 1978; 28: 789-91.PubMedCrossRef Kuo CH, Yonehara N, Hata F, Yoshida H. Subcellular distribution of ascorbic acid in rat brain. Jpn J Pharmacol 1978; 28: 789-91.PubMedCrossRef
22.
Zurück zum Zitat Willis WD, Westlund KN. Neuroanatomy of the pain system and of the pathways that modulate pain. J Clin Neurophysiol 1997; 14: 2-31.PubMedCrossRef Willis WD, Westlund KN. Neuroanatomy of the pain system and of the pathways that modulate pain. J Clin Neurophysiol 1997; 14: 2-31.PubMedCrossRef
23.
Zurück zum Zitat Melethil S, Mason WD, Chian-Jo C. Dose-dependent absorption and excretion of vitamin C in humans. Int J Pharm 1986; 31: 83-9.CrossRef Melethil S, Mason WD, Chian-Jo C. Dose-dependent absorption and excretion of vitamin C in humans. Int J Pharm 1986; 31: 83-9.CrossRef
24.
Zurück zum Zitat Padayatty SJ, Sun H, Wang Y, et al. Vitamin C pharmacokinetics: implications for oral and intravenous use. Ann Intern Med 2004; 140: 533-7.PubMed Padayatty SJ, Sun H, Wang Y, et al. Vitamin C pharmacokinetics: implications for oral and intravenous use. Ann Intern Med 2004; 140: 533-7.PubMed
25.
Zurück zum Zitat Connolly DA, Lauzon C, Agnew J, Dunn M, Reed B. The effects of vitamin C supplementation on symptoms of delayed onset muscle soreness. J Sports Med Phys Fitness 2006; 46: 462-7.PubMed Connolly DA, Lauzon C, Agnew J, Dunn M, Reed B. The effects of vitamin C supplementation on symptoms of delayed onset muscle soreness. J Sports Med Phys Fitness 2006; 46: 462-7.PubMed
26.
Zurück zum Zitat Thomson D, Bailey DM, Hill J, Hurst T, Powell JR, Willilams C. Prolonged vitamin C supplementation and recovery from eccentric exercise. Eur J Appl Physiol 2004; 92: 133-8.CrossRef Thomson D, Bailey DM, Hill J, Hurst T, Powell JR, Willilams C. Prolonged vitamin C supplementation and recovery from eccentric exercise. Eur J Appl Physiol 2004; 92: 133-8.CrossRef
27.
Zurück zum Zitat Erjavec MK, Coda BA, Nguyen Q, Donaldson G, Risler L, Shen DD. Morphine-fluoxetine interactions in healthy volunteers: analgesia and side effects. J Clin Pharmacol 2000; 40: 1286-95.PubMed Erjavec MK, Coda BA, Nguyen Q, Donaldson G, Risler L, Shen DD. Morphine-fluoxetine interactions in healthy volunteers: analgesia and side effects. J Clin Pharmacol 2000; 40: 1286-95.PubMed
Metadaten
Titel
Effect of vitamin C on morphine use after laparoscopic cholecystectomy: a randomized controlled trial
verfasst von
Ghassan E. Kanazi, MD
Mohammad F. El-Khatib, PhD
Vanda G. Yazbeck- Karam, MD
Janane E. Hanna, MSN
Badiaa Masri, MPH
Marie T. Aouad, MD
Publikationsdatum
01.06.2012
Verlag
Springer-Verlag
Erschienen in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 6/2012
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-012-9692-x

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