Modulation of Inflammatory Markers by Perioperative Vitamin C in Head and Neck Cancer Surgery with Flap Reconstruction: A Randomized Controlled Trial

Major head and neck oncologic surgeries cause significant systemic inflammation, with elevated CRP and IL-6. Vitamin C may help reduce perioperative inflammation and improve hemodynamic stability. In this double-blind study, 60 ASA I–II adults scheduled for elective head and neck cancer surgery with flap reconstruction were randomized to receive either intravenous vitamin C (Group C, n = 30; 1 g in 100 mL preoperatively, pre-incision, and before extubation/weaning) or placebo (saline, Group S, n = 30). Serum CRP and IL-6 were measured preoperatively and on postoperative days 1 (POD1) and 4 (POD4). The primary outcome was the serum CRP level on POD1, representing the early postoperative inflammatory response. Secondary outcomes included CRP on POD4, IL-6 levels at POD1 and POD4, vasopressor use, analgesic requirements, postoperative complications, and lengths of ICU and hospital stay. Baseline demographics and preoperative inflammatory markers were similar across groups. On POD1, the mean CRP and IL-6 levels were lower in the vitamin C group compared to placebo (CRP 7.6 ± 1.8 vs. 12.7 ± 6.5 mg/dL, p = 0.001; IL-6 43.3 ± 11.4 vs. 62.2 ± 21.5 pg/mL, p = 0.041). By POD4, these values showed no significant differences. No significant differences were observed in ICU stay, vasopressor use, analgesic requirements, or postoperative complications. However, hospital stay was significantly shorter in the vitamin C group. Perioperative vitamin C reduced early postoperative inflammatory markers, but the effect was transient. The shorter hospital stay observed in the vitamin C group requires confirmation in larger studies.