Cooling for the reduction of postoperative pain: prospective randomized study (original) (raw)
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Cryotherapy Reduced Postoperative Pain in Gynecologic Surgery: A Randomized Controlled Trial
Pain Research and Treatment
Objective. To examine the effectiveness of cryotherapy for reducing postoperative pain in patients who underwent exploratory laparotomy for gynecologic surgery. Materials and Methods. Patients who had indication for an exploratory laparotomy gynecologic procedure were selected by attending physicians to undergo abdominal surgery via low transverse skin incision. The participants were randomized into study and control groups with simple random sampling methods. Cold packs were applied at two hours after operation for 6 hours. The visual analog scale (VAS) score was recorded at two, 6, and 12 hours after operation. Result. One hundred cases were recruited and then divided into study and control groups equally. The mean age of both groups was 43 years. There was no difference in demographics data of both groups. Half of the participants in both groups underwent hysterectomies. At two hours after surgery, both groups had similar VAS scores. The study group had a lower VAS score at 6 and...
Do Ice Packs Reduce Postoperative Midline Incision Pain, NSAID or Narcotic Use?
World Journal of Surgery, 2019
Background Adequate postoperative analgesia, especially after major abdominal surgery is important for recovery, early mobility, and patient satisfaction. We aimed to study the effects of cryotherapy via an ice pack in the immediate postoperative period, for patients undergoing major abdominal operations. Methods This prospective study was conducted at our tertiary care referral center in a low-middle-income country setting. The preoperative patient characteristics, intra-operative variables, and postoperative outcomes were compared between two sets of patients. Cryotherapy was delivered via frozen gel packs for 24 h immediately following laparotomy. Pain relief was assessed with visual analog pain scores (VAS). Comparisons between groups were measured by Chi-square test, Fischer's exact test, or Mann-Whitney U test as appropriate. Results Sixty-eight patients were included in the study: 33 in the cryotherapy group and 35 in the non-cryotherapy group. Mean postoperative pain scores (VAS) were significantly lower in the cryotherapy group versus the control group (3.97 ± 0.6 vs. 4.9 ± 0.7 on postoperative day (POD) 1; p \ 0.001, and 3 ± 0.5 vs. 09 ± 0.8 on POD2; p\ 0.001). The median narcotic use in morphine equivalents was lesser in the cryotherapy group from POD 1-3 (66 (IQR-16) vs. 89 (IQR-17); p = 0.001). No significant difference was seen in the NSAID use between the groups. The cryotherapy group was also found to have a lesser incidence of surgical site infection (p = 0.03) and better lung function based on incentive spirometry (p = 0.01) and demonstrated earlier functional recovery based on their ability to perform the sit-to-stand test (p = 0.001). Conclusion Ice packs are a simple, cost-effective adjuvant to standard postoperative pain management which reduce pain and narcotic use and promote early rehabilitation.
2018
The aim of this randomized control trial, repeated-measure design was to investigate the effects of cold therapy in reducing pain after cardiac surgery during the first 72 postoperative hours. Seventy participants were matched and were randomly assigned to the intervention (n=35) or control group (n=35). The experimental group received a sterile cold gel pack to maintain the skin temperature at 10-15 °C for 20 min. The control group received the routine care. Acute pain was measured using a Thai version of the modified Brief Pain Inventory. The data were analyzed with repeated measures MANOVA. The results showed that the experimental group had significantly lower mean pain than the control group (P<0.001). In addition, pain scores in the experimental group were significantly decreased during the first 72 postoperative hours (P<0.001). Thus, the cold therapy was effective in reducing pain after cardiac surgery during the acute phase.
Evaluation of the contribution to postoperative analgesia by local cooling of the wound
Anaesthesia, 1996
Thirty healthy patients undergoing lumbar spine surgery were randomly assigned to one of two groups .for postoperathie puin relief. Group I received morphine via patient controlled analgesia and local cooling of the wound by an externally applied cooling pad while group 2 received patient controlled analgesia alone. There M'US a signijicanr reduction in morphine consumption when local cooling was applied (18.6mg versus 30.2mg at IZh, 29.0mg iwrsus 49.6mg at 2411, p < 0.05). Patients were also signijicantlj1 more satisfied with their oi1erall postoperatiiw pain management when cooling therapy II'US used.
Defining intraoperative hypothermia in ventral hernia repair
Journal of Surgical Research, 2014
Background: Intraoperative normothermia, a single measurement of core body temperature !36 C, is an important quality metric outlined by the World Health Organization for the reduction of surgical site infections (SSIs). Hypothermia has been linked to SSI in colorectal and trauma patients, but the effect in ventral hernia repair (VHR) is unknown. Materials and methods: Patients who underwent VHR at a single institution between 2005 and 2012 were included. Temperature data were matched with National Surgical Quality Improvement Program SSI data. Novel definitions of hypothermia were explored: patient temperature nadir, percentage of time spent at the nadir, mean temperature, and time spent <36 C. Multivariable regression models were performed. Results: Five hundred fifty-three patients were included with temperature recorded every 8e15 min. Mean temperature nadir was 35.7 C (AE1.3 C [standard deviation]) and was not associated with SSI (odds ratio [OR], 0.938; 95% confidence interval, 0.778e1.131). The percentage of readings spent at the nadir was 31% (AE31%) and was not predictive of SSI (OR, 1.471; 95% CI, 0.983e2.203). As mean temperature increased, the risk of SSI increased (OR, 1.115; 95% CI, 0.559e2.225). Percentage of temperature readings <36 C was 29% (AE38%) and was not associated with SSI (OR, 1.062; 95% CI, 0.628e1.796). In all models, body mass index, smoking, and length of surgery were predictive of SSI. Conclusions: Our results demonstrate no association between temperature and SSI in VHR. Efforts to reduce SSI should focus on factors such as smoking cessation, weight loss, and length of surgery. Our study suggests that maintenance of perioperative normothermia may only decrease SSIs in certain at-risk populations.
Effect of heated and humidified carbon dioxide gas on core temperature and postoperative pain
Surgical Endoscopy, 2002
Background: Intraoperative hypothermia is a common event during laparoscopic operations. An external warming blanket has been shown to be eective in preventing hypothermia. It has now been proposed that using heated and humidi®ed insuation gas can prevent hypothermia and decrease postoperative pain. Therefore, we examined the extent of intraoperative hypothermia in patients undergoing laparoscopic Nissen fundoplication using an upper body warming blanket. We also attempted to determine whether using heated and humidi®ed insuation gas in addition to an external warming blanket would help to maintain intraoperative core temperature or decrease postoperative pain. Methods: Twenty patients were randomized to receive either standard carbon dioxide (CO 2) gas (control, n = 10) or heated and humidi®ed gas (heated and hu-midi®ed, n = 10). After the induction of anesthesia, an external warming blanket was placed on all patients in both groups. Intraoperative core temperature and intraabdominal temperature were measured at 15-min intervals. Postoperative pain intensity was assessed using a visual analogue pain scale, and the amount of analgesic consumption was recorded. Volume of gas delivered, number of lens-fogging episodes, intraoperative urine output, and hemodynamic data were also recorded. Results: There was no signi®cant dierence between the two groups in age, length of operation, or volume of CO 2 gas delivered. Compared with baseline value, mean core temperature increased by 0.4°C in the heated and humidi®ed group and by 0.3°C in the control group at 1.5 h after surgical incision. Intraabdominal temperature increased by 0.2°C in the heated and humidi®ed group but decreased by 0.5°C in the control group at 1.5 h after abdominal insuation. There was no signi®cant dierence between the two groups in visual analog pain scale (5.4 1.6 control vs 4.5 2.8 heated and hu-midi®ed), morphine consumed (27 26 mg control vs 32 19 mg heated and humidi®ed), urine output, lensfogging episodes, or hemodynamic parameters. Conclusion: Heated and humidi®ed gas, when used in addition to an external warming blanket, minimized the reduction of intraabdominal temperature but did not alter core temperature or reduce postoperative pain.
The role of perioperative warming in surgery: a systematic review
Sao Paulo Medical Journal, 2009
OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia. RESUMO OBJETIVO: O objetivo desta revisão é analisar sistematicamente os ensaios sobre a eficácia do aquecimento perioperatório em pacientes cirúrgicos. MÉTODOS: Uma revisão sistemática da literatura foi realizada. Ensaios clínicos sobre aquecimento perioperatório foram selecionados segundo critérios específicos e analisados para gerar dados sumativo expresso na diferença média padronizada (standardized mean difference, SMD). RESULTADOS: Vinte e cinco estudos englobando 3.599 pacientes de várias disciplinas de cirurgia foram obtidos a partir de bases de dados eletrônicas. Dezenove ensaios aleatórios em 1.785 pacientes qualificados para esta revisão. Nenhum grupo de aquecimento desenvolveu estatisticamente significativa hipotermia. No modelo de efeito fixo, grupo de aquecimento tiveram significativamente menos dor e menor incidência de infecção na ferida quando comparado com o grupo de não-aquecimento. No modelo de efeito aleatório, grupo de aquecimento também foi associado a um menor risco de tremores pós-anestesia. Em ambos os modelos de efeitos fixos e aleatórios, o aquecimento foi significativamente associado com menor perda de sangue. No entanto, houve significativa heterogeneidade entre os ensaios. CONCLUSÃO: O aquecimento perioperatório de pacientes cirúrgicos é eficaz na redução da dor pós-operatória ferida, infecção ferida, e tremores. O aquecimento sistêmico do paciente cirúrgico também está associado com menor perda de sangue no perioperatório prevenindo hipotermia e induzindo coagulopatia. O aquecimento perioperatório pode ser administrado rotineiramente a todos os pacientes cirúrgicos de diversas disciplinas, a fim de neutralizar as consequências da hipotermia.
Acta Anaesthesiologica Scandinavica, 1996
Background: The infusion of several liters of crystalloid solution at room temperature may significantly contribute to intraoperative hypothermia because warming fluid to core temperature requires body heat. The aim of this study was to evaluate the effect of delivering warmed intravenous (IV) fluid to the patient on preventing intraoperative hypothermia. Methods: lntraoperative core and mean skin temperatures were measured during prolonged abdominal surgery in 18 patients randomly divided into two groups according to intraoperative IV fluid management. In 9 patients (control group) all IV fluids infused were at room temperature. In the other 9 patients (group receiving warmed fluids) all IV fluids were warmed using an active IV fluid tube-warming system. In all 18 patients a warming blanket covered the skin surface available for cutaneous warming. Intraoperative changes in total body heat content (kJ) were calculated from core and mean skin temperatures.