Department of General Surgery, St. John's Medical College, Bengaluru, India.
Department of Surgical Gastroenterology, Sakra World Hospital, Bengaluru, India.
World J Surg. 2019 Nov;43(11):2651-2657. doi: 10.1007/s00268-019-05129-1.
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.
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.
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).
Ice packs are a simple, cost-effective adjuvant to standard postoperative pain management which reduce pain and narcotic use and promote early rehabilitation.
充分的术后镇痛对于恢复、早期活动和患者满意度尤为重要，特别是在进行大腹部手术后。我们旨在研究冰袋在大腹部手术后即刻进行的冷冻疗法对患者的影响。
本前瞻性研究在我们的中低收入国家三级转诊中心进行。比较了两组患者的术前患者特征、术中变量和术后结果。手术后通过冰冻凝胶包对患者进行 24 小时的冷冻治疗。使用视觉模拟疼痛评分（VAS）评估疼痛缓解情况。使用卡方检验、Fisher 精确检验或 Mann-Whitney U 检验进行组间比较。
本研究纳入 68 例患者：33 例接受冷冻疗法组，35 例接受非冷冻疗法组。与对照组相比，冷冻疗法组的术后平均疼痛评分（VAS）在术后第 1 天（POD1）显著降低（3.97±0.6 比 4.9±0.7；p<0.001），术后第 2 天（POD2）也显著降低（3.0±0.5 比 0.9±0.8；p<0.001）。从 POD1 到 3，冷冻疗法组吗啡等效物的中位数阿片类药物用量较少（66（IQR-16）比 89（IQR-17）；p=0.001）。两组间 NSAID 使用无显著差异。冷冻疗法组的手术部位感染发生率也较低（p=0.03），激励肺活量计显示肺功能更好（p=0.01），并根据其进行坐站测试的能力更早地恢复功能（p=0.001）。
冰袋是一种简单、经济有效的术后疼痛管理辅助手段，可减轻疼痛和阿片类药物的使用，并促进早期康复。
