title: A randomised controlled trial of the effects of cryotherapy on pain, eyelid oedema and facial ecchymosis after craniotomy.
abstract: OBJECTIVE
  To identify the effects of cryotherapy on patient discomfort following craniotomy.
  
  
  BACKGROUND
  Following craniotomy, many patients suffer from unexpected discomfort, including pain, eyelid oedema and ecchymosis. Cryotherapy is regarded as a safe method for managing these postcraniotomy problems.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  A total of 97 Korean patients who underwent elective supratentorial craniotomy were randomly assigned to a cryotherapy or a control group. In the cryotherapy group, ice bags were applied to surgical wounds, and cold gel packs were applied to periorbital areas, for 20 minutes per hour, beginning three hours postoperatively and for three days thereafter. The level of patient pain was measured using the visual analogue scale while the eyelid oedema was measured using the Kara & Gokalan's scale. Ecchymosis was also classified according to its extent.
  
  
  RESULTS
  The level of pain three hours after craniotomy was similar in the cryotherapy and control groups (57.9 vs. 58.7). Three days after surgery, pain had significantly decreased in the cryotherapy group (p = 0.021). After adjusting diagnosis by analysis of covariance (ANCOVA), pain score did not differ significantly between the two groups. The mean eyelid oedema scores were lower in the cryotherapy group than in the control group (0.59 vs. 2.29, p < 0.001), with ANCOVA showing that cryotherapy had a significant effect on eyelid oedema (p < 0.001). Pain (p = 0.047) and eyelid oedema (p < 0.001) in the cryotherapy group were significantly decreased over time. Ecchymosis were significantly less frequent in the cryotherapy (11/48, 22.9%) than in the control (26/49, 53.1%) group (p = 0.003). Logistic regression analysis showed that cryotherapy affected ecchymosis (p = 0.001).
  
  
  CONCLUSIONS
  These results indicate that cryotherapy can control pain, eyelid oedema and facial ecchymosis after craniotomy.
  
  
  CONCLUSIONS
  Cryotherapy, which is both convenient and cost-effective, can be used to prevent postoperative discomforts in a clinical setting.
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, Seoul, Korea. ysshin@amc.seoul.kr
authors.forename: Yong Soon
authors.initials: YS
authors.lastname: Shin
authors.forename: Nan Young
authors.initials: NY
authors.lastname: Lim
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.forename: Kwang Ok
authors.initials: KO
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003399:Craniotomy / Q000009:adverse effects*; D017679:Cryotherapy; D004438:Ecchymosis / Q000628:therapy*; D004487:Edema / Q000628:therapy*; D005143:Eyelids / Q000473:pathology*; D005145:Face / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management