Effect of vitamin C on prevention of complex regional pain syndrome type I in fo

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Foot Ankle Surg. 2009;15(4):179-82. Epub 2009 Apr 5.

Effect of vitamin C on prevention of complex regional pain syndrome type I in

foot and ankle surgery.

Besse JL, Gadeyne S, Galand-Desmé S, Lerat JL, Moyen B.

Université de Lyon, Lyon, France.

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.