Do Ice Packs Reduce Postoperative Midline Incision Pain, NSAID or Narcotic Use?

Abstract

Background Adequate postoperative analgesia, especially after major abdominal surgery is important for recovery, early mobility, and patient satisfaction. We aimed to study the effects of cryotherapy via an ice pack in the immediate postoperative period, for patients undergoing major abdominal operations. Methods This prospective study was conducted at our tertiary care referral center in a low-middle-income country setting. The preoperative patient characteristics, intra-operative variables, and postoperative outcomes were compared between two sets of patients. Cryotherapy was delivered via frozen gel packs for 24 h immediately following laparotomy. Pain relief was assessed with visual analog pain scores (VAS). Comparisons between groups were measured by Chi-square test, Fischer's exact test, or Mann-Whitney U test as appropriate. Results Sixty-eight patients were included in the study: 33 in the cryotherapy group and 35 in the non-cryotherapy group. Mean postoperative pain scores (VAS) were significantly lower in the cryotherapy group versus the control group (3.97 ± 0.6 vs. 4.9 ± 0.7 on postoperative day (POD) 1; p \ 0.001, and 3 ± 0.5 vs. 09 ± 0.8 on POD2; p\ 0.001). The median narcotic use in morphine equivalents was lesser in the cryotherapy group from POD 1-3 (66 (IQR-16) vs. 89 (IQR-17); p = 0.001). No significant difference was seen in the NSAID use between the groups. The cryotherapy group was also found to have a lesser incidence of surgical site infection (p = 0.03) and better lung function based on incentive spirometry (p = 0.01) and demonstrated earlier functional recovery based on their ability to perform the sit-to-stand test (p = 0.001). Conclusion Ice packs are a simple, cost-effective adjuvant to standard postoperative pain management which reduce pain and narcotic use and promote early rehabilitation.

Effect of applying cold gel pack on reduction of postoperative pain in cesarean section, low midline skin incision: A randomized controlled trial

“…After cold pack removal, pain reduction effect lasted for 24 h postoperatively. In parallel, the study of Watkins et al 19 and later study of Ravindhran et al 20 concluded that significant pain reduction and morphine consumption are decreased after open abdominal surgery until postoperative day 3 using 24‐h ice pack compression. The study of Zencir et al 22 applied cold pack on to open heart surgical sites for 20 min.…”

“…There are many theories explaining the mechanisms of cold‐reducing pain mainly involving pro‐inflammatory cytokines suppression and delaying conduction velocity of peripheral nerves. It is proved to be effective in gynecologic surgery, 8,10–12 maxillofacial surgery, 13–14 orthopedic surgery, 15–17 general surgery, 3,18–21 and open heart surgery 22 …”

The Analgesic Effect of Cryotherapy on Patients Undergoing Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial

“…The overall results revealed beneficial outcomes in terms of pain reduction and pain management. [8][9][10][11] The present study is the first to emphasize the effects of cryotherapy or cold application in ESWL treatment. In addition, this study used the change of maximum VAS score from baseline for the primary outcome instead of the patient's stated VAS score after he or she had his/her operation.…”

“…6,7 Many studies have been published in regard to cryotherapy for pain reduction, for example with knee operations, thoracic operations, gynecologic operations, and abdominal operations. [8][9][10][11] However, no previous study has reported the analgesic effect of cryotherapy on ESWL. The aim of this study was to evaluate the effectiveness of cryotherapy regarding pain control during ESWL for urolithiasis treatment.…”

Effect of Cryotherapy on Pain Quality and Intensity among Patients with Thoracotomy after Chest Tube Removal

“…Cryotherapy was a simple, easy applied, effective, noninvasive and safe with low cost nursing intervention to relieve pain. It provided analgesic effect, increase the threshold of pain, enhance patient's autonomy and cooperation and is free from undesirable effects (Hawk, 2017, Ravindhran et al, 2019Tareq et al, 2020). Sandhya and Jebarose (2020) in a study entitled "Effectiveness of Ice Compress Application upon the Level of Pain among Patients with Chest Drainage" concluded that application of ice pack is effective in pain relief and achieving comfort with undesirable effects.…”