Regional vitamin C in Bier block reduces the incidence of CRPS-1 following distal radius fracture surgery
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ORIGINAL ARTICLE
Regional vitamin C in Bier block reduces the incidence of CRPS‑1 following distal radius fracture surgery Mahzad Alimian1 · Amir Sobhani Eraghi2 · Seyyed Alireza Chavoshizadeh1 · Masood Mohseni1 · Elham Mousavi3 · Shima Movassaghi1 Received: 20 August 2020 / Accepted: 21 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Background Systemic vitamin C supplementation after wrist fracture has been suggested to reduce the incidence of complex regional pain syndrome (CRPS). This study aimed to evaluate the effect of regional vitamin C in Bier block in the early phase of fracture on CRPS occurrence following surgery for distal radius fractures. Methods Seventy-four patients with isolated extra-articular distal radius fracture with the plan of fixation under Bier block were enrolled. Patients were assigned randomly into two groups: receiving either 500 mg vitamin C or sterile water as a Bier block adjuvant. Both groups received 500 mg of oral vitamin C for six weeks. The patients were evaluated for CRPS signs and symptoms at 2, 4, 6, and 12 weeks post-surgery. Results The overall incidence of CRPS 12 weeks after surgery in the vitamin C group was significantly less than the controls (22.9% vs 45.5%, p = 0.04). Logistic regression analysis showed that the only significant contribution in predicting the incidence of CRPS came from the intervention variable (OR 0.26, CI95% 0.08–0.85; P = 0.027). Conclusions The findings suggest that adding vitamin C 500 mg to the local anesthetic in Bier block significantly reduces the incidence of CRPS following distal radius fractures. Keywords Vitamin C · Distal radius fracture · CRPS · Pain · Anesthesia
Introduction Complex regional pain syndrome type 1 (CRPS-1) previously known as reflex sympathetic dystrophy is an incapacitating common condition in patients after surgery for distal radius fractures [1, 2]. The form of pain is mainly characterized by the dysfunction of the autonomic nervous system, in which the CRPS patient often experiences neuropathic pain, vasomotor disorders, along with firmness of the joints and soft tissues [3, 4]. Disease prognosis can be highly favorable with timely diagnosis and treatment.
* Masood Mohseni [email protected] 1
Department of Anesthesiology, Iran University of Medical Sciences, Tehran, Iran
2
Department of Orthopaedics Surgery, Iran University of Medical Sciences, Tehran, Iran
3
Department of Sports Medicine, Iran University of Medical Sciences, Tehran, Iran
Certain studies have suggested the ability of vitamin C to restrict damage to soft tissues, consequently preventing CRPS [5]. These studies have shown no negative effects after vitamin C use [6], and animal studies have indicated that taking vitamin C is even associated with improvement of fracture unions [7]. However, data are conflicting [8–11]. To our knowledge, all of earlier studies have proposed longterm oral supplementation of vitamin C; the effects of in situ loading of vitamin C in the early phase after f
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