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Cryotherapy For Post Operative Abdominal Wall Pain

Reed S Oxman Md
 


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Cryotherapy, or the application of ice packs to the wound in the acute post-operative phase, has been shown in several studies to benefit patients’ with post-operative Orthopedic Surgery pain. Cryotherapy can often lower the degree of acute post-operative Orthopedic Surgery pain. At the same time, this therapy can then lower the amount of opiate pain medication needed and requested by patients with post-operative Orthopedic Surgery pain.

Unfortunately for our patients, under treating post-operative pain with sub-therapeutic amounts of opiate pain medication has become, in essence, standard of care. Of course this should not be the case. However, this phenomenon exists for two reasons. First, patients have an unwarranted fear of addiction from an acute use of needed opiate pain medicine. Second, the unwarranted fear of physicians that they will cause addiction in their patients after one warranted prescription of opiate pain medication.

Viraj A. Master, MD, PhD, FACS, an Associate Professor of Urology at Emory University School of Medicine in Atlanta, presented a clinical study at the 2013 Clinical Congress of the American College of Surgeons. His study looked at the effect of Cryotherapy on the degree of post-operative abdominal surgery pain. At the same time, he looked at whether this therapy was associated with a similar decrease in the amount of opiate medication needed and requested by these same patients.

Dr. Master’s clinical study treatment group included 27 post-operative abdominal surgery patients. These patients were given soft ice packs to apply to their incision areas following open abdominal operations. This treatment patient 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. The 28 patients 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 of 0 (no pain) to 10 (the worst possible pain).

According to Dr. Master’s report, patients in the Cryotherapy treatment group reported significantly less pain than those patients in the control group. On average, the treatment group experienced roughly 50% less pain on the first and third postoperative open abdominal surgery days as compared to the control group. In fact, some patients who iced their wounds reported that they used no narcotics.

However, the treatment group used only 22.5% less opioid analgesics on the 1st postoperative day than controls. Based on their reported decrease in overall pain, one would have expected the decrease in opiate usage to be closer to 50%. This discrepancy was not discussed. I believe that there were other behavioral factors at play here and not just the amount of pain reduction with the Cryotherapy.

Dr. Master concluded that abdominal surgeons should offer their pre-operative open abdominal surgery patients information on the benefits of applying soft ice packs to their post-operative abdominal wounds. Of course the ice packs should be removed when the skin becomes too cold.

Dr. Master ended his talk by explaining that in this environment of shrinking medical care dollars and increasing patient desire to have in put into their care, this therapy is very beneficial. Ice packs are safe and inexpensive. They also give the patient a sense of empowerment in their own care.

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