Home' Trinidad and Tobago Guardian : June 18th 2014 Contents A36
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Guardian www.guardian.co.tt Wednesday, June 18, 2014
EXPRESSION OF INTEREST
Using ice as a treatment for surgical wounds, known as cryotherapy, is not new,
Master said. The cold reduces pain by reducing inflammation and swelling, which
lets more oxygen flow to cells, he said.
Patients given ice packs for the first 24 hours after
major abdominal surgeries reported less pain and
needed fewer narcotic painkillers, according to a new
"We aren t talking about saying to a patient, here
is some ice and then cut off all their pain medication.
The ice was only meant to increase the patient care,"
Dr Viraj Master told Reuters Health.
Master, a urologist and professor at Emory University
in Atlanta, Georgia, led the study. He said post-operative
pain is an unavoidable consequence of major surgery.
Although you can make it better with pain medication,
those drugs are not without side effects like constipation,
drowsiness and even dependence.
"The idea was to keep patients out of pain but not
have them suffer from using too many narcotics," he
said. "The physician could give the patient any med-
ication he wanted, we just added the ice."
Ice as a treatment for surgical wounds not new
Using ice as a treatment for surgical wounds, known
as cryotherapy, is not new, Master said. The cold reduces
pain by reducing inflammation and swelling, which
lets more oxygen flow to cells, he said. At the same
time, it slows down the metabolism of a cell so that
less oxygen is needed. It also makes the nerve endings
less sensitive to the pain.
Cryotherapy is commonly used after orthopaedic
and hernia procedures, Master and his coauthors write
in the Journal of the American College of Surgeons.
They wanted to see if it could help patients after major
surgeries too. The researchers recruited 55 patients
scheduled for major abdominal operations, mostly to
remove cancers of the liver, pancreas, colon and other
organs, then randomly assigned them to two groups.
The 27 patients in the cryotherapy group would get
ice for their wounds after their procedure while the 28
assigned to the comparison group would get no ice.
Immediately after surgery, members of the cryother-
apy group were given their ice pack to wear over their
wound for a full 24 hours. Nurses kept the patients
supplied with fresh ice packs during that time.
After the first 24 hours, the patients could use the
ice packs only when they wanted to.
Rating pain level after surgery
For the three days following their surgeries, the
patients rated their pain level twice a day on a scale
of zero to ten. Zero meant no pain, and ten meant the
worst pain imaginable. Their use of narcotic painkillers
was also recorded during that period.
There was no significant difference in how long
patients from either group stayed in the hospital, and
one hour after their procedures, pain levels were not
different in the two patient groups.
But after the first hour and at all points during days
one through three, patients in the cryotherapy group
had lower pain scores than in the comparison group.
On the first morning after surgery, for example, patients
using ice packs rated their pain at three while those
in the comparison group rated theirs at a five.
The researchers also saw a significant difference in
pain on the evening of day three when the ice-treatment
patients had an average pain score of less than two
and the non-ice patients had scores that averaged
The researchers standardised the pain medications
used by patients into units of morphine equivalents
and found that on days one and three, patients in the
cryotherapy group used less medication.
On day one after surgery, patients with ice packs
used about 14 morphine equivalents worth of pain
medication, compared to 17 in the group without ice.
Use of the narcotics shot up on the second day in the
cryotherapy group, but then fell again on day three,
when they used about 11 morphine equivalents compared
to 15 in the non-ice group.
After major surgery, ice
packs may reduce pain
Because ice works locally and only for a short time,
it was not surprising that the effect on narcotic use
only lasted while patients used 24-hour ice packs, the
authors write. Some patients did continue using ice
packs after the first day and said that it helped their
pain. Eighty-one per cent of the cryotherapy group
said the ice brought them some relief, and 76 per cent
said they would use ice packs if they had another sur-
Master noted that safety was a very important part
of the experiment. "There was no wound breakdown
caused by the ice and we conducted the treatment on
a variety of surgical patients," he said.
At US $2 per ice pack, the treatment is cost-effective,
the researchers point out in their report. They also say
that cryotherapy should be complementary to other
pain management strategies because it is easy, affordable,
well-received by patients and has minimal to no toxicity.
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