The Next Best Postop Analgesia – Ice Packs?

As usual, the simplest things are often the best. A recent paper looked at the newest and greatest “drug” to use for providing postoperative analgesia: the good, old-fashioned ice pack!

This concept is obviously not new. Cold is known to quiet inflammation, which is inevitable when tissues are incised. Athletes and their trainers have used ice packs forever. Surgical studies have evaluated their use in orthopedic extremity procedures as well as hernia repairs.

The current paper, from several surgical departments at Emory in Atlanta, randomly allocated patients to have an ice pack placed on their laparotomy incision. Only patients undergoing open abdominal procedures were included. Ice packs were maintained in place for 24 hours, and were then allowed as long as the patient wanted it. Pain, as judged by the analog pain scale, narcotic use, and hospital length of stay were measured. A power analysis was actually performed, and the number of patients required to detect a 15% difference were enrolled (!).

Here are the factoids:

  • 55 patients were enrolled, and were truly randomized
  • Most operations were for pancreatic, gastric, liver, and colorectal cancers
  • The usual demographics of the two groups were identical
  • Pain score was decreased as measured twice later in the day on day 1, and once on day 3
  • Narcotic use was lower on day 1
  • Length of stay was the same for both groups
  • Patients in the cryotherapy group requested to keep the ice packs for an average 2.75 days. None requested removal at the end of day 1.
  • Most stated that they would request an ice pack the next time they had surgery

Bottom line: For once, a nicely done study! Simple and to the point. It reinforces the concept that cheap and simple can still be good. The ice packs in this study were plain old refillable bags filled with ice cubes, not fancy gel or chemical packs that cost lots of money. And the decrease in narcotic use is huge! The side effects of these drugs (constipation, urinary retention, allergic reaction, etc.) create the need for interventions that introduce another whole world of complications.

Consider adding the simple old ice pack to your armamentarium of postop pain relief. But remember, you’ve got to start it as early as possible for best effect, ideally as the surgical dressing is placed.

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Reference: Ice Packs Reduce Postoperative Midline Incision Pain and Narcotic Use: A Randomized Controlled Trial. JACS 10.1016/j.jamcollsurg.2014.03.057, 2014.

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