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 “We aren’t talking about saying to a patient, here is some ice and
then cut off all their pain medication. The ice was only meant to
increase the patient care,” Dr. Viraj Master told Reuters Health.
Master, a urologist and professor at Emory University in Atlanta,
Georgia, led the study. He said post-operative pain is an
unavoidable consequence of major surgery. Although you can make it
better with pain medication, those drugs are not without side
effects like constipation, drowsiness and even dependence.
“The idea was to keep patients out of pain but not have them suffer
from using too many narcotics,” he said. “The physician could give
the patient any medication he wanted, we just added the ice.”
Using ice as a treatment for surgical wounds, known as cryotherapy,
is not new, Master said. The cold reduces pain by reducing
inflammation and swelling, which lets more oxygen flow to cells, he
said. At the same time, it slows down the metabolism of a cell so
that less oxygen is needed. It also makes the nerve endings less
sensitive to the pain.
Cryotherapy is commonly used after orthopedic and hernia procedures,
Master and his coauthors write in the Journal of the American
College of Surgeons. They wanted to see if it could help patients
after major surgeries too.
The researchers recruited 55 patients scheduled for major abdominal
operations, mostly to remove cancers of the liver, pancreas, colon
and other organs, then randomly assigned them to two groups. The 27
patients in the cryotherapy group would get ice for their wounds
after their procedure while the 28 assigned to the comparison group
would get no ice.
Immediately after surgery, members of the cryotherapy group were
given their ice pack to wear over their wound for a full 24 hours.
Nurses kept the patients supplied with fresh ice packs during that
time.
After the first 24 hours, the patients could use the ice packs only
when they wanted to.
For the three days following their surgeries, the patients rated
their pain level twice a day on a scale of 0 to 10. Zero meant no
pain, and 10 meant the worst pain imaginable. Their use of narcotic
painkillers was also recorded during that period.
There was no significant difference in how long patients from either
group stayed in the hospital, and one hour after their procedures,
pain levels were not different in the two patient groups.
But after the first hour and at all points during days one through
three, patients in the cryotherapy group had lower pain scores than
in the comparison group. On the first morning after surgery, for
example, patients using ice packs rated their pain at 3 while those
in the comparison group rated theirs at a 5.
The researchers also saw a significant difference in pain on the
evening of day three when the ice-treatment patients had an average
pain score of less than 2 and the non-ice patients had scores that
averaged almost 4.
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The researchers standardized the pain medications used by patients
into units of morphine equivalents and found that on days one and
three, patients in the cryotherapy group used less medication.
On day one after surgery, patients with ice packs used about 14
morphine equivalents’ worth of pain medication, compared to 17 in
the group without ice. Use of the narcotics shot up on the second
day in the cryotherapy group, but then fell again on day three, when
they used about 11 morphine equivalents compared to 15 in the
non-ice group.
Because ice works locally and only for a short time, it was not
surprising that the effect on narcotic use only lasted while
patients used 24-hour ice packs, the authors write.
Some patients did continue using ice packs after the first day and
said that it helped their pain. Eighty-one percent of the
cryotherapy group said the ice brought them some relief, and 76
percent said they would use ice packs if they had another surgery.
Master noted that safety was a very important part of the
experiment. “There was no wound breakdown caused by the ice and we
conducted the treatment on a variety of surgical patients,” he said.
At $2 per ice pack, the treatment is cost-effective, the researchers
point out in their report. They also say that cryotherapy should be
complementary to other pain management strategies because it is
easy, affordable, well-received by patients and has minimal to no
toxicity.
“Patients may have been getting ice packs from the time they were
kids. Sprained ankle - mom gives you ice pack,” Master said.
Now, he added, patients could reasonably ask their doctor to provide
them with ice packs as well.
SOURCE: http://bit.ly/UoOFvi
Journal of American College of Surgeons, online May 23, 2014.
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