After major surgery, simple ice packs may help reduce pain
NEW YORK (Reuters Health) - Patients given ice packs for the first 24 hours after major abdominal surgeries reported less pain and needed fewer narcotic painkillers, according to a new U.S. study.
“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.
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: bit.ly/UoOFvi Journal of American College of Surgeons, online May 23, 2014.