2938 Abdominal ICE Following Laparoscopic Hysterectomy: A Randomized Controlled Trial

Abstract

Study Objective To assess impact of abdominal ice packs on opioid use and pain control following laparoscopic hysterectomy. Design Randomized controlled trial. Setting Academic tertiary care medical center. Patients or Participants One-hundred-forty-two adult women undergoing laparoscopic (either conventional or robotic) hysterectomy were randomized to control (n=69) or intervention (n=73). Exclusion criteria included preoperative opioid use, planned ICU admission or same-day discharge, an incision ³4 cm, and regional anesthesia use. Interventions Subjects in the intervention group had a large ice pack placed directly on the lower abdomen prior to leaving the operating room. The ice pack was maintained continuously for twelve hours post-op, as desired thereafter until discharge, and continued use encouraged after discharge for up to 48 hours. Measurements and Main Results Total opioids administered postoperatively while inpatient and after dismissal were assessed in morphine metabolic equivalents (MME). Postoperative pain, as well as analgesia acceptability and side effects, were assessed using validated measures, the Brief Pain Inventory (BPI) and Overall Benefit of Analgesia Score (OBAS). Median MME was lower in the intervention group compared to controls from inpatient stay on the floor to completion of opioid use as outpatient (22.5 vs 26.2), but was not statistically significant (p=0.79). There was no significant difference between groups in BPI assessment of postoperative pain severity (p=0.80) or pain interference (p=0.36) or OBAS total score (p=0.88). The majority in the intervention group were very satisfied with ice pack use (n=51, 79.7%) and very likely to recommend to friends or family (n=54, 83.1%). There were no adverse events related to ice pack use. Conclusion There was no significant difference in postoperative opioid use or pain assessment with ice pack use following laparoscopic hysterectomy. However, the majority of subjects expressed high satisfaction with this intervention and would recommend use to others, suggesting potential desirability as adjunct therapy in postoperative pain control.