Department of Obstetrics and Gynecology (Drs. Cope, Wetzstein, Laughlin-Tommaso, and Burnett).
Division of Biomedical Statistics and Informatics (Dr. Mara).
J Minim Invasive Gynecol. 2021 Feb;28(2):342-350.e2. doi: 10.1016/j.jmig.2020.06.027. Epub 2020 Jul 3.
To assess the impact of abdominal ice packs on opioid use and pain control after laparoscopic hysterectomy DESIGN: Randomized controlled trial.
Academic tertiary care medical center.
Total of 142 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy were randomized to control (n = 69) or intervention (n = 73). Exclusion criteria included preoperative opioid use, planned intensive care unit admission or same-day discharge, an incision ≥4 cm, and regional anesthesia use.
Subjects in the intervention group had a large ice pack placed directly on the lower abdomen before leaving the operating room. The ice pack was maintained continuously for 12 hours postoperation, as desired thereafter until discharge, and continued use encouraged after discharge for up to 48 hours.
Total opioids administered postoperatively, while inpatient and after dismissal, were assessed in morphine milligram equivalents. Postoperative pain, as well as analgesia acceptability and side effects, were assessed using validated measures: Brief Pain Inventory and Overall Benefit of Analgesia Score. Median morphine milligram equivalent was lower in the intervention group than the controls from inpatient stay on the floor to completion of opioid use as an outpatient (22.5 vs 26.2) but was not statistically significant (p = .79). There was no significant difference between the groups in Brief Pain Inventory assessment of postoperative pain severity (p = .80) or pain interference (p = .36) or Overall Benefit of Analgesia Score total score (p = .88). Most patients in the intervention group were very satisfied with ice pack use (n = 51, 79.7%) and very likely to recommend it to friends or family (n = 54, 83.1%). There were no adverse events related to ice pack use.
There was no significant difference in postoperative opioid use or pain assessment with ice pack use after laparoscopic hysterectomy. However, most of the subjects expressed high satisfaction specific to ice pack use and would recommend its use to others, suggesting potential desirability as adjunct therapy in postoperative pain control.
评估腹腔镜子宫切除术后腹部冰袋对阿片类药物使用和疼痛控制的影响。
随机对照试验。
学术型三级保健医疗中心。
共纳入 142 例接受腹腔镜（传统或机器人）子宫切除术的成年女性，随机分为对照组（n=69）和干预组（n=73）。排除标准包括术前使用阿片类药物、计划入住重症监护病房或当天出院、切口≥4cm 和使用区域麻醉。
干预组患者在离开手术室前将一个大冰袋直接放在下腹部。冰袋在术后 12 小时内持续使用，此后按需使用直至出院，出院后鼓励继续使用长达 48 小时。
术后使用的总阿片类药物，包括住院期间和出院后，以吗啡毫克当量评估。使用经过验证的措施评估术后疼痛、镇痛可接受性和副作用：简明疼痛量表和整体镇痛获益评分。与对照组相比，干预组从住院到完成门诊阿片类药物使用期间，吗啡毫克当量中位数较低（22.5 与 26.2），但无统计学意义（p=0.79）。两组术后疼痛严重程度（p=0.80）或疼痛干扰（p=0.36）或整体镇痛获益评分总分（p=0.88）均无显著差异。干预组大多数患者对冰袋使用非常满意（n=51，79.7%），非常愿意将其推荐给朋友或家人（n=54，83.1%）。冰袋使用无不良事件相关。
腹腔镜子宫切除术后使用冰袋对术后阿片类药物使用或疼痛评估无显著差异。然而，大多数患者对冰袋使用表示高度满意，并愿意将其推荐给他人，这表明其作为术后疼痛控制辅助治疗的潜在可取性。
