Ice-Pop: Ice Packs for Post-Operative Pain, a Randomized Controlled Trial

Abstract

<h3>Study Objective</h3> To evaluate the benefit of ice packs as a supplement to standard pain management following laparoscopic hysterectomy. <h3>Design</h3> This IRB approved randomized control trial involved patients undergoing outpatient laparoscopic hysterectomy for benign indications. Subjects were randomized to receive standard enhanced recovery after surgery (ERAS) pain management or standard ERAS plus ice packs and followed for two weeks post-operatively. <h3>Setting</h3> Postoperative care unit in two academic tertiary care centers. <h3>Patients or Participants</h3> Patients at two large academic institutions undergoing outpatient laparoscopic hysterectomy via conventional laparoscopic technique with the minimally invasive gynecologic surgery team between February 2019 and November 2020 were considered for participation. Patients with chronic pain, current opioid use more than 1 week, or requiring planned overnight hospitalization were excluded. Primary outcome data was available for 51 subjects (24 control, 27 intervention). <h3>Interventions</h3> Ice packs were placed on the abdomen in the operating room. <h3>Measurements and Main Results</h3> Pain was assessed at multiple time points throughout the study using Visual Analogue Scale (VAS). Narcotic requirement was assessed using morphine milligram equivalent (MME). MME requirements at all time points were not different between the groups (<i>p=0.63)</i>. Postoperative day 1 (POD#1) VAS scores were not different (<i>p=0.</i>89). 84.8% of subjects felt their pain was adequately controlled. All subjects were prescribed 20 tablets oxycodone and on average used 2.9 (SD 3.4) tablets after discharge. 87% of intervention subjects would use ice again in the future and 82.6% would recommend ice to others. <h3>Conclusion</h3> Ice packs are an acceptable supplement for postoperative management with high patient satisfaction and no adverse effects; however, cryotherapy does not significantly impact postoperative reported pain or narcotic use. Providers caring for postoperative patients should be cognizant of unintentional consequences associated with overprescribing opioids and consider reducing the number of tablets prescribed given consistent evidence that patients require less than half the quantity given.