Vitamins can help with the healing process after surgery. Some of the best vitamins for wound healing are those that contain Vitamin C, Vitamin D and E.
Post surgery treatment, including the best supplements to help you nurse your wound and post surgery healing.
vitamins for post surgery healing
It’s no secret that supplementing with vitamins will help heal a wound faster, but there are also many other benefits. Vitamin A is essential for wound healing as it speeds up cellular growth. Vitamin C helps with tissue cell regeneration, and helps reduce inflammation, which can be beneficial to the healing process.
If you have just undergone surgery, or just had one, it is important to follow a diet that provides the right types of vitamins and minerals needed for healing. You need to get ready for your healing process with a good diet and an active lifestyle.
vitamins to reduce swelling after surgery
food items you should eat to heal faster after surgery
After surgery, many people want to take supplements and eat well to improve wound healing, reduce inflammation and all the recovery process by itself. A balanced diet gives you all the nutrients, vitamins and proteins that your body needs, so If your diet is healthy and balanced you don’t need supplements. On the other hand, if there is a nutrient deficiency your surgeon will prescribe you a supplement to fulfill your needs.
If you are a healthy person and want to heal faster from any surgery or illness just eat real food and avoid sugars and process food, simply like that!
Let’s have a look at which nutrients and vitamins play a role during your recovery process.
What does my body need to heal faster?
Vitamin C
Vitamin C is a powerful antioxidant. It helps collagen formation.
It strengthens your connective tissue in your skin, muscle and blood vessels. In addition, Vitamin C reduces inflammation, boosts your immune system and improves wound healing. You can find it in:
Vegetables:
leafy green vegetables,
broccoli,
peppers,
kale,
spinach,
arugula,
mustard greens,
Swiss chard,
brussels sprouts
Fruits:
oranges,
grapefruit,
guava,
blackcurrants,
papayas,
strawberries,
lychees,
persimmons,
kiwis,
and lemons.
On the other hand, there is no proven risk associated with the intake of vitamin c daily but consult with your surgeon first. Some surgeons prescribe a supplement of 1-2 grams daily from wound onset until healing is complete.
Vitamin A
Vitamin A is key and helps us with many important and diverse biological functions. Some of them are: reproduction, embryological development, cellular differentiation, growth, immunity, and vision. Besides, when we talk about wound healing, it stimulates epidermal turnover, promotes collagen production, and accelerates the wound healing process.
Food sources of Vitamin A are:
Leafy green vegetables (kale, spinach, broccoli),
mango, cantaloupe melon, watermelon, orange,
yellow vegetables (carrots, sweet potatoes, pumpkin and other winter squash, summer squash)
tomatoes,
red bell pepper,
cantaloupe,
beef liver,
fish oils,
milk,
eggs
But if you want to intake vitamin A supplements ask your surgeon first.
Zinc
Zinc is an essential micronutrient for your health. As its major role, it regulates every phase of the wound healing process; ranging from membrane repair, oxidative stress, coagulation, inflammation and immune defense, tissue re-epithelialization (resurfacing of a wound with new epithelium/skin or tissues), angiogenesis (process to form new blood vessels), to fibrosis/scar formation. When you are healthy, you get enough zinc through your diet, so there is no need for a supplement. Zinc is found in:
meat,
shellfish,
legumes,
nuts,
seeds,
dairy
and eggs.
Bromelain
Bromelain is a mixture of enzymes that help to digest protein. In addition experts think that it helps to reduce swelling and inflammation after surgery. It is found in the fruit, skin and juice of the pineapple plant. However, if you want to take a supplement of it just ask your surgeon first.
Importance of good nutrition to heal
Protein malnutrition causes a decreased synthesis of protein and cell production; also, reduced immune function, and delayed progression of all phases of wound healing. In addition, vitamin and mineral deficiencies impair tissue synthesis, low energy production, reduced immune function, among others.
7 products to heal faster
1.Leafy green vegetables
They are high in vitamin C, manganese, magnesium, folate, and provitamin A, all of which are essential for immune function and overall health. They’re also rich in polyphenol antioxidants that have powerful anti-inflammatory and immune-supportive properties.
2.Eggs
Following surgery, your body needs more protein than the current recommended for tissue repairing. Daily Allowance (RDA) of 0.36 grams per pound (0.8 grams per kg) of body weight.
After surgery, it is recommended to consume 0. 7–0.9 grams of protein per pound (1.5–2 grams per kg) of your body weight. That is to say, 105–135 grams for a 150-pound (68-kg) person.
3.Salmon
protein, B vitamins, selenium, iron, zinc, and omega-3 fats key in wound healing.
4.Berries
They are full of antioxidants, are a good source of vitamin C. Berries have anti-inflammatory, antiviral, and immune-supporting effects.
5.Nuts and seeds
They are a good source of zinc, vitamin E, manganese, and magnesium. Vitamin E is an antioxidant that protects your body against cellular damage and boosts the immune system. Vitamin E improves the function of protective immune cells that help fight infection and disease.
6.Sweet potatoes
They are a healthy high carb source. Carbs provide energy to your cells (needed for healing) and also enzymes like hexokinase and citrate synthase, which improve wound repair.
7.Cruciferous veggies
These kinds of veggies have glucosinolates, then your body converts them into isothiocyanates. Isothiocyanates main functions are: promote immune health by suppressing inflammation, activating immune defenses, and inducing death in infected cells.
A bit extra…
Arnica Montana
Arnica Montana is a flower that is made into a soothing ointment, gel, cream, or pill that helps you heal with comfort after local trauma.
Surgeons may recommend Arnica Montana (topical gel or cream) to reduce bruising and swelling after surgery, liposuction (5-7 days after surgery), certain facial procedures or injectable treatments (but only on certain areas). Never apply it directly to open wounds or your incisions. Use it to lightly massage the areas of bruising around the cheeks, mouth or lower eyelids. Besides, it has other uses like:
reduce swelling and pain in joints
reduces insect bite discomfort
used in hair tonics and anti-dandruff products
others
We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us 3 mins away from Angel station in Islington. We are always happy to help. If you like this blog, please share!
Introduction
Enhanced Recovery After Surgery (ERAS) protocols have shown significant benefits in multiple areas including early mobilization, improved pain control, and early oral intake. Deficient nutritional states may compromise the operative outcomes. Several essential vitamins, e.g., B12, C, D, and E, have demonstrated anti-inflammatory properties and may promote wound healing. Given the low risk of oral multivitamin supplementation and the potential benefits, we hypothesized that adding a multivitamin to our institution’s ERAS protocols would be a low-cost perioperative intervention accounting for a very small fraction of the annual pharmacy budget.
Methods
A cost analysis for vitamin supplementation for all adult orthopedic surgical cases for the fiscal year 2018 was conducted. To assess the potential cost for multivitamin supplementation in the perioperative period, the fiscal year 2018 pharmacy budget and current costs of multivitamins were obtained from the hospital pharmacy. Medication costs were obtained from the medical logistics ordering system at per unit (i.e., bottle) and per tablet levels for all formulary oral multivitamins. We also determined the number of adult orthopedic surgical cases for our facility in the fiscal year 2018 from our surgery scheduling system. The cost for supplementation for a single day (day of surgery), 1 week (first postoperative week), 6 weeks plus 1 week preop, and 6 months plus 1 week preop for all cases was then calculated.
Results
Our institution’s pharmacy budget for the fiscal year 2018 was $123 million dollars with two oral multivitamins on formulary. Prenatal tablets, containing vitamins A-E, calcium, iron, and zinc, cost $1.52 per bottle of 100 tablets and $0.0152 per tablet, while renal formulation tablets, containing water-soluble vitamins B and C, cost $2.79 per bottle of 100 tablets and $0.0279 per tablet. For one fiscal year, the medication cost to supplement every adult orthopedic surgery patient with an oral multivitamin for 1 day, 1 week, 6 weeks plus 1 week preop, and 6 months plus 1 week preop would range from $60.47 to $110.99, from $423.29 to $776.93, from $2,963.03 to $5,438.51, and from $10,582.25 to $19,423.25, respectively, depending on which multivitamin was prescribed. These costs would represent between 0.00005% and 0.00009% of the annual pharmacy budget for 1 day, between 0.0003% and 0.0006% for 1 week, between 0.00245% and 0.441% for 6 weeks plus 1 week preop, and between 0.00875% and 1.575% for 6 months plus 1 week preop, respectively.
Discussion/Conclusions
The relative nutrient-deficient state in the perioperative patient from decreased oral intake contributes to the metabolic derangements resulting from the surgery. The current ERAS protocols help to mitigate this with early feeding, and the addition of multivitamin supplementation may enhance this process. Multivitamins are safe, widely accessible, and inexpensive, and early investigations of pain control and healing have shown encouraging results. Further prospective studies are needed for incorporating multivitamins into ERAS protocols in order to elucidate the effective dosages, duration of treatment, and effect on outcomes.
Topic: ironcalciumadultappointments and schedulesbudgetsdrug costsformulariesperioperative carepharmaciessurgical procedures, operativetablet dosage formvitaminswound healingpain managementkidneypharmacy (field)prenatal carezincvitamin supplementvitamin b12nutrientsmultivitaminsinduced abortion by dilation and evacuationduration of treatmentearly mobilizationperioperative periodenhanced recovery after surgery
Issue Section: Feature Article and Original Research
INTRODUCTION
Enhanced Recovery After Surgery (ERAS) protocols were developed to improve patient recovery and safety and reduce the hospital costs. These protocols have shown significant patient benefits in multiple areas including early mobilization, improved pain alleviation with multimodal analgesia, and early oral intake.1–3 One of the challenges of this field, however, is implementing new interventions that may increase the costs. An additional challenge is identifying the interventions that are of low risk to the patient. One potential intervention that satisfies both the aforementioned challenges and is yet to be evaluated is the incorporation of multivitamin supplementation into an ERAS strategy. The literature suggests that multiple vitamins (B12, C, D, and E) may have analgesic properties, may promote wound healing, and are well-tolerated by most patients.4–24 The purpose of the current investigation was to determine the cost burden of adding a daily multivitamin to the multimodal analgesia protocol for adult orthopedic surgery patients.
METHODS
To assess the potential cost for multivitamin supplementation in the perioperative period, annual budgets ($131 million for the fiscal year 2019) and costs of multivitamins (prenatal, Nephro-vite) were obtained from the hospital pharmacy. Prenatal vitamins are the available multivitamins at our facility and are dispensed to adults without renal pathology. For those with kidney disease Nephro-vite is dispensed instead. The in-hospital cost for 100 prenatal vitamins is $1.52, while the cost for Nephro-vite is $2.79. The number of adult orthopedic cases for the fiscal year 2018 was then obtained from the hospital’s surgical scheduling system and determined to be 3,978. The cost for vitamin supplementation for 1 day, 1 week, 6 weeks plus 1 week preop, and 6 months plus 1 week preop for the 3,978 patients was then calculated. Of note, the active ingredients in the prenatal vitamins and in Nephro-vite are presented in Table I.
TABLE I.Multivitamin Ingredients
Prenatal Nephro-vite
Vitamin A 4,000 IU
Vitamin C 100 mg 60 mg
Vitamin D 400 IU
Vitamin E 11 IU
Vitamin B1 1.5 mg 1.5 mg
Vitamin B2 1.7 mg 1.7 mg
Vitamin B3 18 mg
Vitamin B6 2.6 mg 10 mg
Folic acid 0.8 mg 1 mg
Vitamin B12 4 mcg 6 mcg
Calcium 263 mg
Iron 27 mg
Zinc 25 mg
Niacinamide 20 mg
d-Biotin 300 mcg
Pantothenic acid 10 mg
The table lists the active ingredients in both the prenatal vitamins and Nephro-vite. Units of measurement are as follows: international units (IU), milligrams (mg), and micrograms (mcg).
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RESULTS
The cost to supplement an individual adult orthopedic surgery patient with a prenatal vitamin for 1 day, 1 week, 6 weeks plus 1 week preop, and 6 months plus 1 week preop would be $0.015, $0.106, $0.753, and $2.625, respectively. The total cost to supplement all adult orthopedic surgery patients during a fiscal year with a prenatal vitamin for 1 day, 1 week, 6 weeks plus 1 week preop, and 6 months plus 1 week preop would be $60.47, $423.29, $2,963.03, and $10,582.25, respectively. These costs would represent 0.00005% (1 day), 0.00035% (1 week), 0.00245% (6 weeks plus 1 week preop), and 0.00875% (6 months plus 1 week preop) of the annual budget (Table II). The cost per patient for the water-soluble Nephro-vite for 1 day, 1 week, 6 weeks plus 1 week preop, and 6 months plus 1 week preop would be $0.028, $0.195, $1.372, and $4.90, respectively. The total cost for supplementation for Nephro-vite 1 day, 1 week, 6 weeks plus 1 week preop, and 6 months plus 1 week preop would be $110.99, $776.93, $5,438.51, and $19,423.25, respectively. These costs would account for 0.00009% (1 day), 0.00063% (1 week), 0.441% (6 weeks plus 1 week preop), and 1.575% (6 months plus 1 week preop) of the annual pharmacy budget (Table II).
Table 2.Cost Analysis
Cost per % Annual
Patient Annual cost Budget
Pre-Natal
One Day $0.015 $60.47 0.00005%
One Week $0.106 $423.29 0.00035%
Six Weeks + One Week Preop $0.735 $2,963.03 0.00245%
Six Months + One Week Preop $2.625 $10,582.25 0.00875%
Nephro-vite®
One Day $0.028 $110.99 0.00009%
One Week $0.195 $776.93 0.00063%
Six Weeks + One Week Preop $1.372 $5,438.51 0.441%
Six Months + One Week Preop $4.90 $19,423.25 1.575%
Table 2 lists the cost per patient, the total cost for all patients and percentage of annual budget to supplement with a pre-natal vitamin and with Nephro-vite® for one day, one week, six weeks plus one week preop and six months plus one week preop.
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DISCUSSION
ERAS protocols have gained traction and interest in the recent years; out of the more than 1,600 articles related to the topic found on PubMed, over half were published since 2016.3 These protocols were compiled after the individual contributing components were rigorously investigated, the effects of metabolic derangements and physical interventions on postoperative recovery were elucidated, and the effectiveness of specific interventions on hastening the recovery process was determined.25 The relative nutrient-deficient state in the perioperative patient due to decreased oral intake contributes to the metabolic derangements resulting from the surgery. The current ERAS protocols help to mitigate this with early feeding.1,3 The addition of multivitamin supplementation may further mitigate these effects.
There are a relatively large number of studies dedicated to examining the effects of vitamin augmentation on pain control and healing, most with very encouraging results.6–30 These range from meta-analysis of the literature to prospective randomized controlled trials. A recently published randomized, double-blind, placebo-controlled trial demonstrates the beneficial effects of vitamin E supplementation on wound healing and metabolic status in patients with diabetic foot ulcers.19 There are also studies demonstrating the benefits of vitamin B supplementation on a variety of pain pathologies, vitamin C supplementation on healing and pain control, and vitamin D supplementation for reduction of chronic pain with the duration of supplementation ranging from a single dose given monthly to 24 weeks of daily supplementation.4–6,8–11,15,16,21,22,24,26–30
The vitamin B complex displays display promising results in the literature regarding pain control, particularly vitamin B12 and to a lesser extent B1 and B6.26–30 Vitamin B12 has been shown to reduce neuropathic pain in rats in both an isolated and a synergistic manner with gabapentin, a commonly used perioperative pain medication.26 Moreover, vitamin B12 was shown to enhance the analgesic properties of morphine and reduce the tolerance development in rat models, suggesting a potential to decrease opioid consumption. In addition to the observed efficacy of pain reduction by vitamin B12 in animal models, several clinical studies have appreciated an effect as well. In regard to musculoskeletal pain, patients with known osteoarthritis experienced greater pain reduction when using diclofenac and vitamin B complex (B1, B3, and B12) compared to diclofenac alone.28 The data regarding perioperative vitamin B12 supplementation are sparse but promising. One study noted a decrease in opioid consumption in women status post cesarean section when taking gabapentin with vitamin B complex (B1, B2, B3, and B6) compared to gabapentin alone.29 Ponce-Monter et al. appreciated a decrease in perioperative pain scores in patients using diclofenac with vitamin B complex (B1, B6, and B12) compared to diclofenac alone in patients with lower-extremity fractures.30 The neuromodulating effects of vitamin B12 have been established at the cellular level and the existing data suggest synergistic and isolated analgesic properties; however, further clinical trials in the surgical setting are warranted.26–30
Perhaps the most well-known vitamin discussed in the orthopedic literature is vitamin C. The American Academy of Orthopaedic Surgeons recommends adjuvant treatment of distal radius fractures with vitamin C for the prevention of disproportionate pain.11 While more recent literature may suggest a controversy with regard to the efficacy of vitamin C in reducing the incidence of complex regional pain syndrome, there are numerous other studies that support its benefit in the postoperative patient.4–6,8–10 A randomized controlled trial by Li et al. in 2018 demonstrated an improved postoperative healing with postoperative vitamin C supplementation in dental implant surgery with and without the use of bone graft.21 Mohammad et al. in 2016 showed that vitamin C favorably impacts the expression of transcription factors associated with the early resolution of inflammation and tissue remodeling.22 Finally, an article published in The Journal of Foot and Ankle Surgery demonstrated a trend in vitamin C intake and faster recovery of skin integrity and strength across wounds in a guinea pig model.24
As previously mentioned, a proposed strength of this study involves the administration of relatively low-risk supplements at a low cost. Nevertheless, administration of any exogenous substrate is not entirely risk free. In regard to vitamin C, there is a concern that despite its primarily antioxidant capabilities, there is some concern for its prooxidant effects that may be detrimental to tissue healing. Yet as mentioned above, the available data largely support the role of vitamin C in would healing (i.e., increased tissue remodeling transcription factor activity, increased dental extraction wound healing, and increased wound healing in guinea pigs).21,22,24 A noted concern for vitamin A supplementation involves the decreased bone resorption and the increased risk of hip fractures as presented in the Iowa Women’s Trial where the authors noted a “small, elevated risk compared with nonusers” but delineated that the risk of all types of fractures was not increased with vitamin A supplementation.31 Additionally, there was no dose-dependent effect for vitamin A use and the risk of fracture. Furthermore, the women in the vitamin A supplement group were also more likely to be on thyrotropic medications and hormone replacement which confounds the findings. Based on the data, there would not be a large concern for the short-term vitamin A use in a similar population. Folate supplementation, in the setting of active colon cancer, has been shown to promote tumor growth, in contrast to the protection it provides in normal colonic mucosa.32 Other research evaluating cervical and breast cancer have been inconclusive regarding the effect of folate on tumor growth enhancement.33 This risk could be avoided by implementing a screening tool for active colorectal cancer as part of an exclusion criteria in the future studies. Finally, concern has been raised for a potential increased risk of lung cancer in active smokers using vitamin E. However, Huang et al. showed no increased risk in the population from a prospective trial in 2020 involving 22,781 patients, and similar results were found in a meta-analysis of 11 studies by Chen et al. in 2015.34,35 Lastly, it is known that iron-containing supplements can interfere with the absorption of certain medications including bisphosphonates, thyroid medications, and certain antibiotics. A reasonable way to avoid this would be appropriately spacing the medication administration throughout the day. While risks exist with the use of vitamin supplementation, the literature as a whole support a favorable benefit-to-risk ratio.
The future looks bright for vitamin supplementation in the perioperative patient, yet there has been a recent critique of ERAS protocols for instituting additional components without sufficient robust scientific inquisition showing a statistically significant benefit and for extrapolating data to other surgical fields (original studies done in colorectal surgery).3 There is a concern that this may lead to expensive, ineffective, and potentially unsafe interventions.3 This is a valid concern. However, the multivitamins we examined are safe, sold over-the-counter, and, as we have shown, are very inexpensive. As recently discussed, there are numerous studies demonstrating the benefit of vitamin supplementation on pain control and healing.6–30 However, while many of these studies demonstrate a benefit in animal models or at a biochemical level, there is limited evidence demonstrating a clinically significant benefit in patients. Thus, further investigation in the form of prospective randomized controlled trials is warranted.
CONCLUSION
The current ERAS protocols help to mitigate the metabolic derangements associated with surgery and the relative nutrient-deficient state in the perioperative patient. Multivitamin supplementation may impart multiple benefits, and supplementation through the perioperative period imparts minimal financial burden. Further prospective studies are needed for incorporating multivitamins into ERAS protocols in order to elucidate the effective dosages, duration of treatment, and effect on outcomes.