The effect of intravenous vitamin C administration on postoperative pain and intraoperative blood loss in older patients after intramedullary nailing of trochanteric fractures.

Abstract

Purpose: The purpose of this study was to determine the effects of peri and postoperative intravenous vitamin C administration on severity of postoperative pain and intraoperative blood loss in patients with trochanteric fracture treated with intramedullary nailing.

Methods: A prospective, single-blinded, controlled, randomised clinical study was conducted. It included 60 patients who were randomly divided into the Vitamin C and Control groups. Baseline characteristics, haemoglobin levels, number of Red Blood Cell (RBC) units transfusion, and metamizole consumption were noted in each group. Visual Analogue Scale (VAS) score was evaluated at 24 and 48 h postoperatively.

Results: There were no differences between the groups concerning age, gender, length of hospitalisation, fracture type distribution, preoperative and postoperative haemoglobin levels. Postoperative metamizole consumption was higher in the Control group than in the Vitamin C group, with statistically significant difference (p = 0.003). The median VAS scores were higher in the Control group compared to the Vitamin C group at 24 and 48 h postoperatively with significant differences (p = 0.001 and p < 0.0005, respectively). Multivariate logistic regression analysis revealed two independent predictors of postoperative blood transfusion: unstable fracture pattern (OR = 0.065, 95% CI 0.007-0.571, p = 0.014), and preoperative haemoglobin level (OR = 903, 95% CI 0.846-0.965, p = 0.003).

Conclusion: The results showed significant reduction of subjective pain levels and lower analgesic consumption in patients who received intravenous vitamin C, suggesting that it could be considered as an adjuvant agent for analgesia in older patients with hip fracture. Unstable fracture pattern and preoperative haemoglobin levels significantly contributed to postoperative blood transfusion requirement.