Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery
Received 25 November 2008; accepted 13 February 2009. published online 06 April 2009.
Abstract
Background
The public health cost impact of complex regional pain syndrome type I (CRPS I) is considerable in both emergency and scheduled orthopaedic surgery. We proposed to assess the effectiveness of vitamin C in prevention of CRPS I in foot and ankle surgery.
Methods
We carried out a “before–after” quasi-experimental study comparing two chronologically successive groups without (Group I: July 2002–June 2003) and with (Group II: July 2003–June 2004) preventive 1g daily vitamin C treatment. All patients having surgery on the foot or ankle were enrolled, with the exception of diabetic foot cases. Several factors were analysed: sex, age, type of pathology, history of CRPS I, psychological context, tourniquet time, and cast immobilisation time.
Results
420 feet (392 patients) were included in the study: 185 in Group I, 235 in Group II. CRPS I occurred in 18 cases in Group I (9.6%) and 4 cases in Group II (1.7%) (p<10−4), with history of CRPS I as a significantly correlated factor (relative risk=10.4). The psychological context (anxio-depressive state) showed a (sub-significant) tendency to increase the risk of CRPS I (relative risk=2.6).
Conclusion
Vitamin C has been shown to be effective in preventing CRPS I secondary to wrist fracture, but few data are available with respect to foot and ankle cases. The present study demonstrates the effectiveness of vitamin C in preventing CRPS I of the foot and ankle—a frequent complication in our control group (9.6%). The authors recommend preventive management by vitamin C.
aUniversité de Lyon, Lyon, France, INRETS, LBMC UMR_T 9406, Université Lyon 1, Hôspital Lyon-Sud, Service de Chirurgie Orthopédique, Pierre-Bénite, F - 69495, France
bService de chirurgie orthopédique et de médecine du sport, Centre Hospitalier Lyon-Sud, F-69495 Pierre-Bénite, France
cDépartement d’Information Médicale des Hospices Civils de Lyon, 162, avenue Lacassagne, F-69424 Lyon Cedex 03, France
Corresponding author at: Centre Hospitalier Lyon-Sud, Orthopaedic Surgery Department, 69495 Pierre-Bénite Cedex, France. Tel.: +33 4 78 86 14 27; fax: +33 4 78 86 59 34.
ABSTRACT