Efficacy and safety of perioperative vitamin C in patients undergoing noncardiac surgery: a systematic review and meta-analysis of randomised trials.

Abstract

BACKGROUND:

Perioperative oxidative stress plays a role in organ injury and pain and could be improved by the antioxidant effects of vitamin C.

METHODS:

We performed a systematic review and meta-analysis of RCTs comparing perioperative vitamin C administration vs placebo or no treatment in adults undergoing noncardiac surgery. The primary outcome was hospital length of stay (LOS).

RESULTS:

Thirty-seven RCTs and 2747 patients were included. Administration of vitamin C was associated with no difference in LOS (mean difference=0.02 day; 95% confidence interval [CI], -0.30 to 0.35; P=0.88). Mortality did not differ between groups (relative risk=1.04; 95% CI, 0.52 to 2.08; P=0.5). No trials reported on other major postoperative complications. Vitamin C was associated with a reduction in postoperative pain score and cumulative morphine consumption up to 48 h after surgery. The incidence of complex regional pain syndrome was lower in orthopaedic patients receiving vitamin C. Adverse events were present in three RCTs (n=157), absent in 10 RCTs (n=957), and not reported in 25 RCTs (n=1570). One trial (n=20) in kidney transplantation surgery was stopped early because of safety concerns on vitamin C. The quality of evidence ranged from moderate to very low.

CONCLUSIONS:

Administration of vitamin C was not associated with a decrease in LOS after noncardiac surgery. The effects on morbidity and mortality are inconclusive and mostly uninvestigated. A small reduction in postoperative pain was found. Adverse events were rare but not systematically assessed. The evidence is uncertain, not supporting the use of vitamin C outside an experimental setting.

STUDY PROTOCOL:

PROSPERO database, CRD42021241654.

• Authors: Manuel Suter, Bernardo Bollen Pinto, Alessandro Belletti, Alessandro Putzu
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 128 Issue 4 Pg. 664-678 (Apr 2022) ISSN: 1471-6771 [Electronic] England
• PMID: 35090721 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Morphine
• Ascorbic Acid

Topics

• Adult
• Ascorbic Acid (adverse effects)
• Humans
• Length of Stay
• Morphine
• Pain, Postoperative (drug therapy)
• Postoperative Complications (epidemiology, prevention & control)
• Randomized Controlled Trials as Topic