• Eur J Orthop Surg Tr · Feb 2020

    Influence of vitamin C on the incidence of CRPS-I after subacromial shoulder surgery.

    • P Laumonerie, M Martel, M E Tibbo, V Azoulay, P Mansat, and N Bonnevialle.
    • Department of Orthopedic Surgery, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France. laumonerie.pierre@hotmail.fr.
    • Eur J Orthop Surg Tr. 2020 Feb 1; 30 (2): 221-226.

    PurposeThe primary aim of this study was to determine whether postoperative administration of vitamin C (VC) is associated with reduced risk of complex regional pain syndrome type I (CRPS-I) after subacromial shoulder surgery (SaSS). The secondary objective of the study was to identify risk factor for the development of CRPS-I after SaSS.Materials And MethodsA retrospective cohort study was performed to evaluate 542 patients undergoing SaSS from January 2015 to December 2016. The cohort was divided into two groups based on VC administration [Group I (no VC) and Group II (500 mg/day oral VC for 50 days postoperatively)]. The relationship between VC administration and development of CRPS-I was assessed. Demographics, preoperative clinical parameters, and operative variables were evaluated to determine their effect on the incidence of CRPS-I.ResultsA total of 267 patients (Group II) undergoing SaSS received VC, and 266 patients (Group I) did not. The incidence of CRPS-I was significantly different between two groups (36(13%) vs 18(7%), p = 0.009). Multivariable regression, however, demonstrated that VC reduced the risk of CRPS-I after SaSS by > 50% (aOR = 0.49; 95% CI 0.27-0.91). Patients undergoing open surgery (aOR = 2.19; 95% CI 1.2-4.0) were more likely to develop CRPS-I postoperatively. Higher preoperative Constant score (aOR = 0.94; 95% CI 0.91-0.98) was associated with lower risk for CRPS-I development.ConclusionsThe present study found that VC administered prophylactically for 50 days postoperatively is effective in preventing CRPS-I development after SaSS. CRPS-I is a common complication following SaSS, especially in the setting of an open approach. The authors recommend preventive management with VC and arthroscopic approaches when possible for SaSS.Level Of Evidence IiiRetrospective comparative study.

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