Intravenous Vitamin C Reduces Pain and Opioid Use After Hip Replacement

A double-blind, placebo-controlled, randomized trial found that a single 3-gram dose of intravenous vitamin C during hip replacement reduced postoperative morphine use, pain scores, and inflammation for patients undergoing total hip arthroplasty (THA), though the changes did not exceed clinically significant thresholds.

Although THA is an effective surgical treatment for advanced hip conditions, postoperative pain management remains a significant concern among orthopedic surgeons. Postoperative pain is often managed with opioids despite the potential for associated adverse events such as postoperative nausea and vomiting. Additionally, ineffective post-surgical pain management can potentially lead to complications including increased risks of myocardial infarction, pneumonia, anxiety, and depression. Emerging evidence suggests that vitamin C, with its antioxidant and analgesic properties, may serve as a safe and effective adjunct for pain management, though its role in THA pain relief has yet to be investigated.

To fill this gap, Hand and colleagues assigned 100 patients to receive either a 3-gram dose of intravenous vitamin C or a placebo during surgery. Researchers then measured postoperative morphine consumption, pain scores, and inflammatory markers to assess the effects of vitamin C.

Patients in the study were prescribed celecoxib for pain control, with subcutaneous morphine available as needed. The vitamin C group had lower postoperative morphine consumption and lower pain scores at rest and during movement in the first 24 hours after surgery. Range of motion at the hip joint was also improved in the vitamin C group during this period. Additionally, inflammatory markers, including C-reactive protein and interleukin-6, were significantly lower in patients who received vitamin C.

The reductions in morphine use and pain scores did not exceed the minimal clinically important difference thresholds established for these measures. The study was conducted at a single center, and all patients underwent general anesthesia, limiting generalizability to other settings. The follow-up period was limited to the hospitalization phase, preventing assessment of long-term outcomes. Patients received only a single dose of vitamin C, and it is unclear whether repeated dosing would have a different effect on postoperative pain.

“This clinical study demonstrated that intravenous injection vitamin c can provide less opioid consumption, VAS pain scores after THA,” the study authors concluded. “However, the changes in morphine consumption and VAS scores did not reach the established minimal clinically important differences.”

Resource
Han G, Gan Y, Wang Q, Sun S, Kang P. Effect of perioperative single dose intravenous vitamin C on pain after total hip arthroplasty. J Orthop Surg Res. 2024;19(1):712. Published 2024 Nov 2. doi:10.1186/s13018-024-05193-x