Oleh Admin Kalbe Medical pada April 21, 2017 07:30

Vitamin C Menurunkan Prevalensi Sindrom Nyeri Regional Kompleks Setelah Fraktur Pergelangan Tangan

Bukti epidemiologi saat ini menunjukkan bahwa defisiensi vitamin C telah dikaitkan dengan nyeri spinal, khususnya pada leher, punggung bawah, dan nyeri artritis/rematik. Vitamin C menunjukkan efek regulasi pada sel-sel sistem skeletal, termauk osteogenik, kondrogenik, dan osteoblasgenik. Hipovitaminosis C (kadar vitamin C <23 µmol/L) telah dilaporkan pada pasien usia lanjut yang dirawat di rumah sakit, pasien dengan penyakit kritis, dan pasien kanker. Pasien trauma dan pembedahan, serta pasien infeksi berat dan sepsis, juga secara bermakna mengalami penurunan kadar vitamin C. Asupan vitamin C 100-200 mg/hari dapat memberikan status vitamin C plasma yang jenuh pada individu sehat, namun dosis lebih tinggi diperlukan untuk menormalisasi status vitamin C pada pasien bedah atau dengan penyakit kritis.

Lebih lanjut, kumpulan bukti menunjukkan bahwa pemberian vitamin C dapat memberikan efek analgesik pada beberapa kondisi klinik. Sejumlah mekanisme telah diajukan untuk efek analgesik vitamin C, antara lain sebagai kofaktor biosintesis peptida opioid teramidasi. Vitamin C berperan dalam amidasi peptida, melalui kerjanya sebagai kofaktor untuk peptidyl-glycine α-amidating monooxygenase, yang merupakan satu-satunya enzim untuk mengamidasi residu terminal karboksi dari neuropeptida dan hormon peptida. Mekanisme yang diajukan tersebut didukung dengan penurunan kebutuhan analgesik opioid pada pasien bedah dan kanker yang diberikan vitamin C dosis tinggi.

Sejumlah uji klinik acak dengan kontrol juga telah meneliti efek suplementasi vitamin C pada kejadian sindrom nyeri regional kompleks (CRPS) pada pasien operasi pergelangan tangan dan kaki. Dosis yang digunakan antara 200-1500 mg/hari selama 45-50 hari pascaoperasi. Semua studi, kecuali satu studi, menunjukkan penurunan kejadian CRPS pada pasien yang mendapat vitamin C, dengan dosis yang paling efektif adalah ≥500 mg/hari, sehingga disimpulkan bahwa pemberian vitamin C harian dapat menurunkan kejadian CRPS setelah operasi fraktur distal. Salah satunya studi acak, tersamar ganda, dan multisenter pada 416 pasien dengan 427 fraktur pergelangan tangan yang diterapi secara operatif maupun non-operatif. Pasien secara acak mendapat vitamin C 200 mg, 500 mg, 1500 mg, atau plasebo per hari selama 50 hari.

Hasilnya menunjukkan bahwa 317 pasien dengan 328 fraktur mendapat vitamin C dan 99 pasien dengan 99 fraktur mendapat plasebo. Prevalensi CRPS 2,4% pada kelompok vitamin C vs 10,1% pada kelompok plasebo (p=0,002), di mana semua pasien yang terkena adalah wanita usia lanjut. Analisis dari dosis vitamin C yang berbeda menunjukkan prevalensi CRPS 4,2% pada kelompok 200 mg (RR 0,41; 95% CI 0,13-1,27), 1,8% pada kelompok 500 mg (RR 0,17; 95% CI 0,04-0,77), dan 1,7% pada kelompok 1500 mg (RR 0,17; 95% CI 0,04-0,75).

Disimpulkan bahwa vitamin C dapat menurunkan prevalensi CRPS setelah fraktur pergelangan tangan dan dianjurkan pemberian vitamin C dengan dosis 500 mg/hari selama 50 hari. (EKM)

Image : Ilustrasi
Referensi:
1.Carr AC, McCall C. The role of vitamin C in the treatment of pain: New insights. J Transl Med. 2017;15(1):77.
2.Zollinger PE, Tuinebreijer WE, Breederveld RS, Kreis RW. Can vitamin C prevent complex regional pain syndrome in patients with wrist fractures? A randomized, controlled, multicenter dose-response study. J Bone Joint Surg Am. 2007;89(7):1424–31.

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