title: Ice packs reduce postoperative midline incision pain and narcotic use: a randomized controlled trial.
abstract: BACKGROUND
  Postoperative pain is an unavoidable consequence of open abdominal surgery. Although cryotherapy, the application of ice to a surgical wound site, has been shown to be effective in reducing postoperative pain in orthopaedic, gynecologic, and hernia operations, it has not been assessed in patients who undergo major open abdominal operations. We hypothesized that patients who receive cryotherapy would report lower pain scores as a primary outcomes measure.
  
  
  METHODS
  Patients undergoing abdominal operations with midline incisions were randomized to receive cryotherapy for a minimum of 24 hours in time intervals dictated by patient preference vs no cryotherapy. The primary outcome of pain relief was assessed with visual analog pain scores (VAS). The study was powered to detect a clinically significant difference in VAS between the control and cryotherapy group. Comparisons between groups were measured by Student's t-test or Mann-Whitney U test for parametric and nonparametric data, respectively.
  
  
  RESULTS
  There were 55 patients randomized: 28 to the control group and 27 to the cryotherapy group. For the primary measure, mean postoperative pain score on postoperative days (PODs) 1 and 3 after surgery was significantly lower between the control and cryotherapy groups on the visual analog pain scale (p < 0.005). Narcotic use was decreased in the cryotherapy group on POD 1 by 3.9 morphine equivalents (p = 0.008). No statistically significant difference was found between the 2 treatment groups with respect to length of hospital stay, pulmonary complications, and wound infection rate in terms of secondary measures.
  
  
  CONCLUSIONS
  Ice packs are a simple, cost-effective adjuvant for decreasing postoperative pain and narcotic use in patients undergoing major abdominal operations.
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Ammara A
authors.initials: AA
authors.lastname: Watkins
authors.affiliation: Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Johnson
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Shrewsberry
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Paymon
authors.initials: P
authors.lastname: Nourparvar
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Tarik
authors.initials: T
authors.lastname: Madni
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Colyn J
authors.initials: CJ
authors.lastname: Watkins
authors.affiliation: Department of Urology, Emory University, Atlanta, GA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Feingold
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Division of Surgical Oncology, Emory University, Atlanta, GA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Division of Surgical Oncology, Emory University, Atlanta, GA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA; Division of Surgical Oncology, Emory University, Atlanta, GA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Staley
authors.affiliation: Department of Urology, Emory University, Atlanta, GA; Division of Surgical Oncology, Emory University, Atlanta, GA. Electronic address: vmaster@emory.edu.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
mesh_terms: D000005:Abdomen / Q000601:surgery*; D005260:Female; D006801:Humans; D007053:Ice; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000628:therapy*
chemical_list: D007053:Ice; D009294:Narcotics