The Impact of Intravenous Vitamin C Combined With Nerve Blocks on Postoperative Pain and Recovery After Total Knee Arthroplasty

The Impact of Intravenous Vitamin C Combined With Nerve Blocks on Postoperative Pain and Recovery After Total Knee Arthroplasty.

The aim of this prospective randomized-control study was to evaluate the impact of a single high-dose intravenous vitamin C added to ultrasound-guided blocks at induction on postoperative pain, sngception and early functional rehabilitation of the knee joint in patients under-going total knee arthroplasty.

Study Overview

• Status: Completed
• Conditions: Postoperative Pain; Ascorbic Acid
• Intervention / Treatment: Drug: Control Rx; Drug: Ascorbic acid 100mg/kg, Maximus 10g

• Study Type: Interventional
• Enrollment (Actual): 73
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Tainan City
    • Tainan, Tainan City, Taiwan, 701
      • Chi Mei Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Physical status according to American Society of Anesthesiologists (ASA) I-III
2. Patients scheduled for total knee arthroplasty
3. Patients aged ranging from 50 to 80 years old

Exclusion Criteria:

1. Previous operation on the same knee
2. Allergy or intolerance to one of the study medications
3. Coagulopathy
4. Having lower limbs neuropathy
5. End-organ failure (CKD stage IV or V, NYHA III or IV)
6. BMI > 35
7. Chronic opioid use (>3 months) or drug abuser
8. Difficulty in communication (Impaired mental status)
9. Hyperuricemia or Glucose-6-phosphate dehydrogenase deficiency patient

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Control arm; Intravenous loading of the same volume Normal saline as experimental arm	Drug: Control Rx; Intravenous loading 100ml normal saline
Experimental: Vitamin C arm; Intravenous loading of 100mg/kg ascorbic acid before induction, Maximus 10g	Drug: Ascorbic acid 100mg/kg, Maximus 10g; Intravenous loading of 100mg/kg ascorbic acid with normal saline, totally 100ml Completed before induction

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric rating scale for pain	11-point numeric scale ranges from '0' representing no pain to '10' representing the extreme pain	15 minutes postoperatively
Numeric rating scale for pain	11-point numeric scale ranges from '0' representing no pain to '10' representing the extreme pain	1 hour postoperatively
Numeric rating scale for pain	11-point numeric scale ranges from '0' representing no pain to '10' representing the extreme pain	6 hours postoperatively
Numeric rating scale for pain	11-point numeric scale ranges from '0' representing no pain to '10' representing the extreme pain	24 hours postoperatively
Numeric rating scale for pain	11-point numeric scale ranges from '0' representing no pain to '10' representing the extreme pain	48 hours postoperatively
Numeric rating scale for soreness (Sngception)	11-point numeric scale ranges from '0' representing no soreness to '10' representing the extreme soreness	15 minutes after surgery
Numeric rating scale for soreness (Sngception)	11-point numeric scale ranges from '0' representing no soreness to '10' representing the extreme soreness	1 hours postoperatively
Numeric rating scale for soreness (Sngception)	11-point numeric scale ranges from '0' representing no soreness to '10' representing the extreme soreness	6 hours postoeratively
Numeric rating scale for soreness (Sngception)	11-point numeric scale ranges from '0' representing no soreness to '10' representing the extreme soreness	24 hours postoperatively
Numeric rating scale for soreness (Sngception)	11-point numeric scale ranges from '0' representing no soreness to '10' representing the extreme soreness	48 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Time to first rescue morphine requirement at post-anesthetic care unit	Duration from arriving post-anesthetic care unit to requiring first morphine injection	up to 2 hours
Severity of postoperative nausea/ vomiting and dizziness	From 0 to 5, 0: non, 1: mild, 2: moderate, 3: severe, 4: unbearable	48 hours postoperatively
Morphine consumption	Amount of IV morphine consumption postoperatively	48 hours postoperatively

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood ascorbic acid concentration	Blood ascorbic acid analysis	Preoperative baseline and postoperative day1
PostOP Knee joint range of motion	In degree from zero to 170	72 hours postoperatively

Collaborators and Investigators

• Sponsor: Chimei Medical Center
• Investigators: Study Director: Jen-Yin Chen, Department of Anesthesiology, Chimei Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): November 2, 2022
• Primary Completion (Actual): December 13, 2023
• Study Completion (Actual): January 11, 2024

Study Registration Dates

• First Submitted: August 16, 2022
• First Submitted That Met QC Criteria: August 22, 2022
• First Posted (Actual): August 24, 2022

Study Record Updates

• Last Update Posted (Estimated): November 19, 2025
• Last Update Submitted That Met QC Criteria: November 17, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Ascorbic Acid; Total knee arthroplasty; Regional analgesia
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Pain, Postoperative; Cariostatic Agents; Organic Chemicals; Carbohydrates; Sugar Acids; Acids, Acyclic; Carboxylic Acids; Hydroxy Acids; Inorganic Chemicals; Biomedical and Dental Materials; Manufactured Materials; Technology, Industry, and Agriculture; Fluorides; Hydrofluoric Acid; Fluorine Compounds; Tin Compounds; Ascorbic Acid; Tin Fluorides
• Other Study ID Numbers: CMMC11104/016

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No