O19: FROZEN GEL-PACKS REDUCE POST-OPERATIVE PAIN AND NARCOTIC USAGE IN PATIENTS UNDERGOING SURGERY FOR BREAST CANCER

Abstract

Abstract Introduction Adequate post-operative analgesia is important for recovery, early rehabilitation and patient satisfaction. We aimed to prove that patients undergoing surgery for breast cancer who receive cryotherapy via frozen gel-packs in the immediate postoperative period would report lower pain, require lesser narcotics and pain medication. Method This prospective randomized study was conducted at our tertiary care referral centre in South India. The pre-operative characteristics, intra-operative variables and post-operative outcomes were compared between two sets of matched cases and controls. Cryotherapy was delivered via frozen gel-packs for 12 hours immediately following surgery. Pain relief was assessed with the visual analog pain scale(VAS). Comparisons between groups were measured by the chi-square test, Fischer's-exact test, Independent samples t-test or Mann-Whitney U test as appropriate. Result 81 patients were included in the study( Study-group=41 and control-group=40). For the primary outcome, mean postoperative pain score on postoperative days(PODs) 1(5.13±0.648 vs. 4.44±.502; t (79) = 5.3; p<0.001) and POD 5(4.1±0.9 vs. 3.29±.642; t (79)=3.26; p<0.001) were significantly lower in the cryotherapy group. The overall post-operative narcotic requirement(morphine equivalence) was reduced in the cryotherapy group(61.32±9.4 vs 55.8±11; t(79) = 2.421; p=0.018). The overall paracetamol requirement(grams) was also reduced in the cryotherapy group(2.1±.38 vs 1.9±.36; t(79) = 2.66; p=0.009). No significant difference was seen in the NSAID use between the groups. The cryotherapy group also demonstrated earlier functional recovery and lesser shoulder and arm stiffness(p=0.015). Conclusion Cryotherapy is a simple, cost-effective adjuvant to standard postoperative pain management which reduces pain, narcotics and promotes early rehabilitation. Take-home message Ice packs are a simple, cost-effective adjuvant to standard postoperative pain management which reduces pain, narcotic use and promotes early rehabilitation.