Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery.
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).


CONCLUSIONS
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.
Université de Lyon, Lyon, France. jean-luc.besse@chu-lyon.fr
Jean-Luc
JL
Besse
Sylvain
S
Gadeyne
Sophie
S
Galand-Desmé
Jean-Luc
JL
Lerat
Bernard
B
Moyen
D000293:Adolescent; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000601:surgery*; D000975:Antioxidants / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology / Q000517:prevention & control*; D013577:Syndrome; D016896:Treatment Outcome; D055815:Young Adult
D000975:Antioxidants; D001205:Ascorbic Acid