Vitamin C Could Prevent Complex Regional Pain Syndrome Type I in Trauma and Orthopedic Care? A Systematic Review of the Literature and Current Findings

The influence of high doses of vitamin C on functional recovery and postoperative pain in patients with trochanteric fracture after intramedullary nailing during a three-month follow-up: a full-scale study

PURPOSE

To determine the effects of high peri- and postoperative doses of vitamin C administration on severity of pain in postoperative period and functional outcome of the patients with trochanteric fracture treated with intramedullary nailing during a three-month follow-up.

METHODS

A prospective, randomised, full-scale study included 74 patients who were randomly divided into vitamin C (intervention) and control groups. In the intervention group, patients received vitamin C perioperatively by intravenous route for 2 days, and oral vitamin C for 38 days postoperatively. Baseline characteristics, postoperative metamizole consumption, visual analogue scale (VAS) score, Harris hip score (HHS) value, and the prevalence of complications were evaluated in both groups.

RESULTS

No significant differences were noted between the groups regarding age, gender, length of hospitalisation, and distribution in fracture type as well as in postoperative HHS values. Postoperative metamizole consumption was notably higher in the control group compared to the vitamin C group (p = 0.003). Postoperative VAS scores were higher in the control group than in the vitamin C group at all time follow-ups (p < 0.05). The group variable significantly contributed to VAS score, and age and gender variables significantly contributed to HHS value.

CONCLUSION

Significant reduction of subjective pain levels and lower analgesic consumption was found in patients who received vitamin C, suggesting that it should be considered as an adjuvant agent for analgesia in patients with hip fracture.

Effects of Multiple Intravenous Doses of Perioperative Vitamin C on Pain Management Following Total Hip Arthroplasty

Purpose

Although the benefits of numerous intravenous vitamin C doses during the perioperative phase on postoperative pain following total hip arthroplasty for whether patients could have pain relief for a longer period of time have not yet been tested, a single dose of vitamin C can assist control pain after the procedure on the first post-operative day.

Methods

One hundred patients undergoing total hip arthroplasty (THA) at our institution were enrolled in this prospective, double-blind, placebo-controlled, randomized experiment. These patients were randomized to either the control group or the vitamin C group. While the control group received an equivalent daily dose of a placebo, the vitamin C group received an intravenous injection of 3g of vitamin C every day during the perioperative period. Ten milliliters of morphine were injected subcutaneously as a rescue analgesic for patients who complained of discomfort following surgery. The amount of morphine used for rescue analgesia and the levels of inflammatory markers were the main outcomes that we evaluated. Additionally, we evaluated postoperative pain and hip joint recovery using the Visual Analog Scale (VAS) as secondary outcomes.

Results

In the vitamin C group, the subcutaneous morphine injection dosage was considerably lower (0-24h 6.1mg ± 2.7mg vs 4.0mg ± 2.9mg, p = 0.000, total use 8.3mg ± 3.1mg vs 6.6mg ± 3.9mg, p = 0.018). During the perioperative term, the vitamin C group experienced better hip motion and lower VAS pain levels at rest and during exercise.

Brachioradialis tendon transfer and palmaris longus tendon graft for thumb avulsion: A case report and review of literature

BACKGROUND

Thumb replantation following complete traumatic avulsion requires complex techniques to restore function, especially in cases of avulsion at the level of the metacarpophalangeal joint (MCP I) and avulsion of the flexor pollicis longus (FPL) at the musculotendinous junction. Possible treatments include direct tendon suture or tendon transfer, most commonly from the ring finger. To optimize function and avoid donor finger complications, we performed thumb replantation with flexion restoration using brachioradialis (BR) tendon transfer with palmaris longus (PL) tendon graft.

CASE SUMMARY

A 20-year-old left-handed male was admitted for a complete traumatic left thumb amputation following an accident while sliding from the top of a handrail. The patient presented with skin and bone avulsion at the MCP I, avulsion of the FPL tendon at the musculotendinous junction (zone 5), avulsion of the extensor pollicis longus tendon (zone T3), and avulsion of the thumb's collateral arteries and nerves. The patient was treated with two stage thumb repair. The first intervention consisted of thumb replantation with MCP I arthrodesis, resection of avulsed FPL tendon and implantation of a silicone tendon prosthesis. The second intervention consisted of PL tendon graft and BR tendon transfer. Follow-up at 10 months showed good outcomes with active interphalangeal flexion of 70°, grip strength of 45 kg, key pinch strength of 15 kg and two-point discrimination threshold of 4 mm.

CONCLUSION

Flexion restoration after complete thumb amputation with FPL avulsion at the musculotendinous junction can be achieved using BR tendon transfer with PL tendon graft.

The effect of intravenous vitamin C administration on postoperative pain and intraoperative blood loss in older patients after intramedullary nailing of trochanteric fractures

PURPOSE

The purpose of this study was to determine the effects of peri and postoperative intravenous vitamin C administration on severity of postoperative pain and intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing.

METHODS

A prospective, single-blinded, controlled, randomised clinical study was conducted. It included 60 patients who were randomly divided into the Vitamin C and Control groups. Baseline characteristics, haemoglobin levels, number of Red Blood Cell (RBC) units transfusion, and metamizole consumption were noted in each group. Visual Analogue Scale (VAS) score was evaluated at 24 and 48 h postoperatively.

RESULTS

There were no differences between the groups concerning age, gender, length of hospitalisation, fracture type distribution, preoperative and postoperative haemoglobin levels. Postoperative metamizole consumption was higher in the Control group than in the Vitamin C group, with statistically significant difference (p = 0.003). The median VAS scores were higher in the Control group compared to the Vitamin C group at 24 and 48 h postoperatively with significant differences (p = 0.001 and p < 0.0005, respectively). Multivariate logistic regression analysis revealed two independent predictors of postoperative blood transfusion: unstable fracture pattern (OR = 0.065, 95% CI 0.007-0.571, p = 0.014), and preoperative haemoglobin level (OR = 903, 95% CI 0.846-0.965, p = 0.003).

CONCLUSION

The results showed significant reduction of subjective pain levels and lower analgesic consumption in patients who received intravenous vitamin C, suggesting that it could be considered as an adjuvant agent for analgesia in older patients with hip fracture. Unstable fracture pattern and preoperative haemoglobin levels significantly contributed to postoperative blood transfusion requirement.

Effect of perioperative single dose intravenous vitamin C on pain after total hip arthroplasty

INTRODUCTION

Vitamin c can relieve the pain after other diseases, but there are no studies on whether vitamin C can relieve the pain after hip replacement. The purpose of this paper is to study whether vitamin C can relieve the pain after total hip replacement.

PURPOSE

In this prospective, double-blind, placebo-controlled, randomized trial, 100 patients receiving THA at our hospital were randomly assigned to vitamin c or control groups. During the operation, the vitamin C group will receive intravenous injection of 3 g vitamin C, and the control group will receive 3 g placebo. If the patient has postoperative pain, 10 ml subcutaneous injection of morphine will be required as a rescue analgesic. The primary outcome was the amount of postoperative injection of morphine as a rescue analgesic and expression of inflammatory factors, and the secondary outcome was postoperative pain and hip recovery as assessed by visual analog scale (VAS).

RESULTS

The dosage of subcutaneous injection of morphine was significantly reduced in vitamin C group. VAS pain scores at rest and exercise were lower in the vitamin C group 24 h after surgery, and hip motion was better 24 h after surgery, but there was no significant difference between the two groups 24 h after surgery.Nonetheless, the overall changes in morphine usage and VAS scores did not surpass the established minimal clinically important differences (10 mg for morphine consumption; 1.5 at rest and 1.8 during movement for VAS scores).

CONCLUSION

Adding intravenous vitamin c to multimodal analgesia significantly improved morphine consumption, VAS pain score, and functional recovery. However, it is recommended that single intravenous administration of vitamin C during the perioperative period may achieve better pain relief for patients after THA.