Does the vitamin C level affect postoperative analgesia in patients who undergo orthognathic surgery?


      Vitamin C has a critical role in pain management because of its antioxidative, neuroprotective, and anti-nociceptive properties. Oxidative stress caused by surgery increases the requirement for vitamin C. The aim of this study was to evaluate the change in vitamin C level and its effect on postoperative pain in patients undergoing orthognathic surgery. Thirty patients were included in the study. The relationships between the postoperative plasma vitamin C level, duration of surgery, postoperative analgesic consumption, and pain scores (visual analogue scale) were analysed. The difference between the mean pre- and postoperative vitamin C levels was found to be statistically significant (7.5 ± 2.9 mg/l vs 4.9 ± 2.3 mg/l, respectively; P = 0.001). There was no significant relationship between the duration of surgery and the vitamin C level decrease (P > 0.05). There was an inverse correlation between the postoperative vitamin C level and the amount of analgesic requested via patient-controlled analgesia (r = −0.699, P < 0.001). The findings suggest that, in patients who undergo orthognathic surgery, plasma vitamin C levels decrease significantly (34.6%), and an increase in the duration of surgery is not associated with any decrease in the vitamin C levels. A low postoperative plasma vitamin C level was found to be associated with greater postoperative analgesic consumption. In patients with preoperative plasma vitamin C levels ≤ 42 µmol/l, perioperative vitamin C administration may be considered for postoperative pain management.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to International Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jeon Y.
        • Park J.S.
        • Moon S.
        • Yeo J.
        Effect of intravenous high dose vitamin C on postoperative pain and morphine use after laparoscopic colectomy: a randomized controlled trial.
        Pain Res Manag. 2016; 20169147279
        • Fukushima R.
        • Yamazaki E.
        Vitamin C requirement in surgical patients.
        Curr Opin Clin Nutr Metab Care. 2010; 13: 669-676
        • Marik P.E.
        Vitamin C: an essential “stress hormone” during sepsis.
        J Thorac Dis. 2020; 12: 84-88
        • Pirbudak L.
        • Balat Ö.
        • Cekmen M.
        • Ugur M.G.
        • Aygün S.
        • Öner Ü.
        Effect of ascorbic acid on surgical stress response in gynecologic surgery.
        Int J Clin Pract. 2004; 58: 928-931
        • Carr A.C.
        • McCall C.
        The role of vitamin C in the treatment of pain: new insights.
        J Transl Med. 2017; 1577
        • Kiabi F.H.
        • Soleimani A.
        • Habibi M.R.
        • Zeydi A.E.
        Can vitamin C be used as an adjuvant for managing postoperative pain? A short literature review.
        Korean J Pain. 2013; 26: 209-210
        • Kanazi G.E.
        • El-Khatib M.F.
        • Yazbeck-Karam V.G.
        • Hanna J.E.
        • Marri B.
        • Aouad M.T.
        Effect of vitamin C on morphine use after laparoscopic cholecystectomy: a randomized controlled trial.
        Can J Anaesth. 2012; 59: 538-543
        • 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 Ankle Surg. 2009; 15: 179-182
        • Byun S.H.
        • Jeon Y.
        Administration of vitamin C in a patient with herpes zoster—a case report.
        Korean J Pain. 2011; 24: 108-111
        • Aldrete J.A.
        The post-anesthesia recovery score revisited.
        J Clin Anesth. 1995; 7: 89-91
        • Carr A.C.
        • Shaw G.M.
        • Natarajan R.
        Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock?.
        Crit Care. 2015; 19418
        • Duarte T.L.
        • Lunec J.
        Review: when is an antioxidant not an antioxidant? A review of novel actions and reactions of vitamin C.
        Free Radic Res. 2005; 39: 671-686
        • Travica N.
        • Ried K.
        • Hudson I.
        • Scholey A.
        • Pipingas A.
        • Sali A.
        The effects of surgery on plasma/serum vitamin C concentrations: a systematic review and meta-analysis.
        Br J Nutr. 2022; 127: 233-247
        • Tunay D.L.
        • Ilgınel M.T.
        • Ünlügenç H.
        • Tunay M.
        • Karacaer F.
        • Biricik E.
        Comparison of the effects of preoperative melatonin or vitamin C administration on postoperative analgesia.
        Bosn J Basic Med Sci. 2020; 20: 117-124
        • Moon S.
        • Lim S.H.
        • Cho K.
        • Kim M.H.
        • Lee W.
        • Cho Y.H.
        The efficacy of vitamin C on postlaparoscopic shoulder pain: a double-blind randomized controlled trial.
        Anesth Pain Med. 2019; 14: 202-207
        • Ayatollahi V.
        • Dehghanpour Farashah S.
        • Behdad S.
        • Vaziribozorg S.
        • Rabbani
        • Anari M.
        Effect of intravenous vitamin C on postoperative pain in uvulopalatopharyngoplasty with tonsillectomy.
        Clin Otolaryngol. 2017; 42: 139-143
        • Zollinger P.
        • Tuinebreijer W.
        • Breederveld R.S.
        • Kreis R.W.
        Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose–response study.
        J Bone Joint Surg Am. 2007; 89: 1424-1431
        • Jain S.K.
        • Dar M.Y.
        • Kumar S.
        • Yadav A.
        • Kearns S.R.
        Role of anti-oxidant (vitamin-C) in post-operative pain relief in foot and ankle trauma surgery: a prospective randomized trial.
        Foot Ankle Surg. 2019; 25: 542-545
        • Chen S.
        • Roffey D.M.
        • Dion C.A.
        • Arab A.
        • Wai E.K.
        Effect of perioperative vitamin C supplementation on postoperative pain and the incidence of chronic regional pain syndrome: a systematic review and meta-analysis.
        Clin J Pain. 2016; 32: 179-185
        • 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.
        Clin J Pain. 2009; 25: 562-569
        • Schencking M.
        • Vollbracht C.
        • Weiss G.
        • Lebert J.
        • Biller A.
        • Goyvaerts B.
        • Kraft K.
        Intravenous vitamin C in the treatment of shingles: results of a multicenter prospective cohort study.
        Med Sci Monit. 2012; 18: CR215-CR224
        • Kim M.S.
        • Kim D.J.
        • Na C.H.
        • Shin B.S.
        A study of intravenous administration of vitamin C in the treatment of acute herpetic pain and postherpetic neuralgia.
        Ann Dermatol. 2016; 28: 677-683
        • Liu Y.
        • Wang M.
        • Xiong M.M.
        • Zhang X.G.
        • Fang M.
        Intravenous administration of vitamin C in the treatment of herpes zoster-associated pain: two case reports and literature review.
        Pain Res Manag. 2020; 20208857287
        • Chaitanya N.C.
        • Muthukrishnan A.
        • Krishnaprasad C.
        • Sanjuprasanna G.
        • Pillay P.
        • Mounika B.
        An insight and update on the analgesic properties of vitamin C.
        J Pharm Bioallied Sci. 2018; 10: 119-125
        • Chaitanya N.C.
        • Badam R.
        • Siva Prasad Reddy G.
        • Alwala A.
        • Srinivas P.
        • Saawarn N.
        • Chintada S.
        • Akhila M.
        • Bontala P.
        • Inamdar P.
        • Mannava H.
        Analgesic effect of intravenous ascorbic acid versus aceclofenac post-transalveolar extraction.
        J Popul Ther Clin Pharmacol. 2019; 26: e43-e52
        • Biswas N.R.
        • Verma K.
        • Bhartiya P.
        • Bhartiya P.
        • Vajpayee R.B.
        Topical ascorbic acid after LASIK: short term effects.
        JK Pract. 2005; 12: 225-227
        • Barness L.A.
        Safety considerations with high ascorbic acid dosage.
        Ann N Y Acad Sci. 1975; 258: 523-528
        • Liu F.
        • Zhu Y.
        • Zhang J.
        • Li Y.
        • Peng Z.
        Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial.
        BMJ Open. 2020; 10e039519
        • Wang Y.
        • Lin H.
        • Lin B.W.
        • Lin J.D.
        Effects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis.
        Ann Intensive Care. 2019; 958