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Ice-pop: ice packs for postoperative pain, a randomized controlled trial

      Objectives

      To evaluate the benefit of ice packs as supplement to standard pain management following laparoscopic hysterectomy.

      Materials and Methods

      This IRB approved randomized control trial was conducted at 2 tertiary care hospitals. Patients undergoing laparoscopic hysterectomy with the minimally invasive gynecologic surgery team were considered for inclusion. Patients with chronic pain, current opioid use ≥1 week, or requiring admission were excluded. Subjects were randomized to receive standardized enhanced recovery after surgery (ERAS) management or standardized ERAS plus ice packs. Ice packs were applied to the abdomen after skin closure in the operating room. Pain was assessed using Visual Analogue Scale (VAS). Narcotic requirement was assessed using morphine milligram equivalent (MME).

      Results

      Primary outcome data was available for 54 subjects (24 control, 27 intervention). There was no difference between the groups’ demographic data. There was no difference in time to discharge between groups (control, μ=241 minutes; intervention, μ=237 minutes; p=0.90), nor was there a correlation between time to discharge and preoperative VAS (r=0.14, N=51, p=0.34) or discharge VAS (r=-0.01, N=44, p=0.95). There was no difference in MME requirements between the groups, although in post-anesthesia recovery unit (PACU), MME for intervention subjects was slightly less (μ=4.6, SD 5.4) compared to controls (μ=5.3, SD 15.3), (p=0.63). Postoperative day 1 (POD#1) VAS were not different (p=0.89). 84.8% subjects felt their pain was adequately controlled. Subjects that felt their pain was not controlled did not use more narcotics POD#1 (p=0.37), nor have higher POD#1 VAS (p=0.55). All subjects were prescribed 20 tablets oxycodone and averaged 2.9 (SD 3.4) total tablets used after discharge. 87% of intervention subjects would use ice in the future and 82.6% would recommend ice to others. There were no ice related adverse events.

      Conclusion

      Ice packs are an acceptable supplement for postoperative management with high patient satisfaction and no adverse effects, but do not significantly impact postoperative reported pain or narcotic use.
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