Reply to the letter by Ashih Jaiman

Abstract

I read with interest your pertinent comments about possible side effects of Vitamin C at 1000 mg for 45 days in prevention of Complex Regional Pain Syndrome type I in foot and ankle surgery [1]. When I began my prospective study in 2002, there were only two publications: the randomised study by Zollinger [2] using 500 mg Vitamin C and that of Cazeneuve [3] with 1000 mg. So I made the choice of 1000 mg for my study. As I clearly discussed in my article [1], three years after the end of our study, Zollinger published a second randomised study [4] comparing the prevention effect of three Vitamin C doses (200– 500–1500 mg) in wrist fractures, Zollinger found a dose effect with a prevalence of CRPS I of 10.1% in his placebo group, 4.2% in the 200-mg group, 1.8% in the 500-mg group and 1.7% in the 1500-mg group, and finally concluded that a daily dose of 500 mg for fifty days is to be recommended. But as our study used a 1000 mg Vitamin C protocol for Foot and Ankle surgery, it is logical for us to recommend this dose. For six years, our orthopaedic and traumatologic department has used this protocol for all operations. We can estimate that more than 10,000 patients received this 1000 mg Vitamin C prevention and we never observed any adverse effects. We only checked history of (uric acid) kidney stone. However I agree that in light of the last Zollinger publication [4], 500 mg of Vitamin C is probably enough.