Effect of Vitamin D Supplementation on Post Craniotomy Pain after Brain Tumor Surgery: a Randomized Clinical Trial
MelikaHMI-KetabforoushMSc1 Mohammadreza Shahmohammadi MD 2 BatoulKhoundabiPh.D3 Zahra Vahdat ShariatpanahiMD, Ph.D1
World Neurosurgery, https://doi.org/10.1016/j.wneu.2019.05.250
300,000 IU injection only raised blood levels from 16 ng ==> 23 ng
Generally no benefit is found in any kind of study when blood levels are less than 30 ng
Oral vitamin D is about 20X less expensive and results in 5X faster response - wonder why they used injection
- Vitamin D injection of 600,000 IU (response by 10 individuals)– Sept 2017
- 4 - 12 weeks for injection to peak.
- Doubt that the surgery patients were given the injection more than a week before the surgery
- all 10 started with a much higher level of vitamin D than the brain surgery patients
- previous report on this study:
VitaminDWiki suggests
One dose a week before the surgery
The second dose just after the surgery
Doses can probably be oral – no indication that injection is better
Injection might actually be worse for surgery due to slower response
Injection category contains the following
- Vitamin D injections last longer (3 month vs 2 month) than loading doses
- Getting Vitamin D into your body shows the many ways of getting Vitamin D
- Injections are currently made by medical professionals into muscle
- Home injection of Vitamin D appears to be possible in the future
- Injections are useful for people who might forget to take their periodic supplement (children, elderly, etc) and those who cannot swallow or have poor digestion
- While Vitamin D2 is historically the common form, Vitamin D3 is far better
- Should check (if there is time) for possible allergic reaction to Vitamin D or lack of Magnesium for both for loading dose and injection
- Note 600,000 IU Vitamin D loading dose via capsules is 1/20th the cost($2.40) of an injection, and does not require a prescription
- 100,000 IU single dose of vitamin D - 2010 has the following
- Vitamin D injection lasts longer and has bigger response than weekly oral – Jan 2017 has the following
- Non-oral Vitamin D should be a better form for MS, food allergy, PTSD, etc. – many studies might include injection
Objective: To determine the effect of vitamin D supplementation on post-operative pain and analgesic requirement in brain tumor surgery.
Methods: A total of 60 patients with vitamin D serum level of ≤ 20 ng/dL were randomly assigned to two groups equally. The study group (n=30) received intramuscular injection of 300,000 IU vitamin D before surgery.
Results
Preoperative serum level of vitamin D was 15.9±3.8 ng/dL and 14.5±3.6 ng/dL in the study and control groups, respectively (P= 0.13). Serum level of vitamin D on day 5 of surgery was 22.5±4.3 and 13.7±3.8 in the study and control groups, respectively (P<0.001). A percentage of 50% had pain scores above 4 on the first postoperative day, which decreased with time. The median (IQR) of the visual analogue scale (VAS) score during the three post-operative days was 3(5), 3(5), 1(3) and 5(7), 2(5), 1(3) in the study and control groups, respectively, with no significant difference. There was no difference in analgesic consumption between the two groups. Analysis through the Generalized Estimating Equation model indicated that patients who had received vitamin D for a longer time before the operative time had an insignificantly less pain score.
Conclusion
Based on the study results, half of our patients reported moderate to severe pain scores on the first day after surgery. The pain in the study group was insignificantly less than that in the control group, but it seems that chronic high level of vitamin D may lead to promising results.
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