Post-Op Ice Application Lessens Pain with Fewer Narcotics

Postoperative pain is often undertreated because prescribers and patients fear the potential side effects and drug dependence risks of effective opioid treatment. In an effort to expunge those concerns, a study presented at the 2013 Clinical Congress of the American College of Surgeons has demonstrated that a simple postoperative pain treatment decreases both pain and the use of narcotic pain relievers.

According to Viraj A. Master, MD, PhD, FACS, an associate professor of urology at Emory University School of Medicine in Atlanta, “we now know that it is more effective to use combination treatments that reduce the amount of narcotics needed.” The combination treatment that Master proposed in his study includes an ice pack application after major abdominal operations, coupled with opioids.

Cryotherapy, which involves the application of ice to a surgical wound, reduces pain safely and effectively after some procedures, especially orthopedic surgery. However, little evidence has been available for cryotherapy in patients who undergo large-incision abdominal operations.

Master’s small study measured the pain of 27 patients after applying soft ice packs to their incision areas following open abdominal operations, and then compared it to the pain of 28 patients with no ice application. Patients in the cryotherapy group applied ice packs to their wounds at desired intervals for at least 24 hours, and they also had the option of taking prescribed opioids. Those in the no-ice control group received only opioids for pain relief. Twice a day, all patients rated their pain intensity using a standard pain scale.

Patients who used ice packs reported significantly less pain than those who did not. On average, the cryotherapy group experienced about 50% less pain on the 1st and 3rd postoperative days compared to the control group, the investigators said. Additionally, the cryotherapy group used 22.5% less opioid analgesics on the 1st postoperative day than controls. In fact, some patients who iced their wounds reported that they used no narcotics.

Master advised surgeons to recommend that their patients who have open abdominal operations intermittently apply ice packs to the surgical wound and only remove them when it becomes too cold.

“An ice pack is safe and inexpensive, gives the patient a sense of empowerment because it is self-care, and doesn’t require high-tech devices,” Master said.