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Effect of Perioperative Vitamin C Supplementation on Postoperative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-analysis.

Authors » Chen S , Roffey DM , Dion CA , Arab A , Wai EK

Journal » The Clinical journal of pain

Year » 2016

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OBJECTIVES:: Postoperative pain can contribute to increased risk for complications and lengthened hospital stays. The objective was to analyze the effects of perioperative vitamin C supplementation on postoperative pain and the development of complex regional pain syndrome I (CRPS I) in patients undergoing surgical procedures. METHODS:: A systematic review of published literature was performed through April 2014. References from relevant studies were scanned for additional studies. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. RESULTS:: The search strategy yielded 710 studies, of which 13 were included: seven on postoperative pain and six on CRPS I. In the final analysis, one relevant study found a reduction in postoperative morphine utilization after preoperative vitamin C consumption, while another showed no difference in postoperative pain outcomes between the vitamin C and control groups. A meta-analysis of three applicable CRPS I studies showed a decrease in postoperative CRPS I after perioperative vitamin C supplementation (relative risk (RR)=2.25; tau=0). DISCUSSION:: There is moderate level evidence supporting the use of a 2 g preoperative dose of vitamin C as an adjunct for reducing postoperative morphine consumption, and high level evidence supporting perioperative vitamin C supplementation of 1 g per day for 50 days for CRPS I prevention after extremity surgery. Additional studies are necessary to increase the level of evidence to determine the overall effectiveness and optimum dosage of vitamin C.

Efficacy and Safety of High-dose Vitamin C on Complex Regional Pain Syndrome in Extremity Trauma and Surgery-Systematic Review and Meta-Analysis

Authors » Shibuya N , Humphers JM , Agarwal MR , Jupiter DC

Journal » The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

Year » 2013

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Complex regional pain syndrome (CRPS) is a devastating condition often seen after foot and ankle injury and surgery. Prevention of this pathology is attractive not only to patients but also to surgeons, because the treatment of this condition can be difficult. We evaluated the effectiveness of vitamin C in preventing occurrence of CRPS in extremity trauma and surgery by systematically reviewing relevant studies. The databases used for this review included: Ovid EMBASE, Ovid MEDLINE, CINAHL, and the Cochrane Database. We searched for comparative studies that evaluated the efficacy of more than 500 mg of daily vitamin C. After screening for inclusion and exclusion criteria, we identified 4 studies that were relevant to our study question. Only 1 of these 4 studies was on foot and ankle surgery; the rest concerned the upper extremities. All 4 studies were in favor of this intervention with minimal heterogeneity (Tau2 = 0.00). Our quantitative synthesis showed a relative risk of 0.22 (95% confidence interval = 0.12, 0.39) when daily vitamin C of at least 500 mg was initiated immediately after the extremity surgery or injury and continued for 45 to 50 days. A routine, daily administration of vitamin C may be beneficial in foot and ankle surgery or injury to avoid CRPS. Further foot and ankle specific and dose-response studies are warranted. © 2013 American College of Foot and Ankle Surgeons.

OBJECTIVES:

: Postoperative pain can contribute to increased risk for complications and lengthened hospital stays. The objective was to analyze the effects of perioperative vitamin C supplementation on postoperative pain and the development of complex regional pain syndrome I (CRPS I) in patients undergoing surgical procedures.

METHODS:

: A systematic review of published literature was performed through April 2014. References from relevant studies were scanned for additional studies. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale.

RESULTS:

: The search strategy yielded 710 studies, of which 13 were included: seven on postoperative pain and six on CRPS I. In the final analysis, one relevant study found a reduction in postoperative morphine utilization after preoperative vitamin C consumption, while another showed no difference in postoperative pain outcomes between the vitamin C and control groups. A meta-analysis of three applicable CRPS I studies showed a decrease in postoperative CRPS I after perioperative vitamin C supplementation (relative risk (RR)=2.25; tau=0).

DISCUSSION:

: There is moderate level evidence supporting the use of a 2 g preoperative dose of vitamin C as an adjunct for reducing postoperative morphine consumption, and high level evidence supporting perioperative vitamin C supplementation of 1 g per day for 50 days for CRPS I prevention after extremity surgery. Additional studies are necessary to increase the level of evidence to determine the overall effectiveness and optimum dosage of vitamin C.

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