Appendectomy patients give ice a thumbs-up for controlling pain | Image Credit: Contemporary Pediatrics

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Patients believe cold therapy helps alleviate pain after an appendectomy, a recent study found. Such therapy does not reduce the need for narcotics, however, according to the results of the randomized controlled trial.

Investigators divided into 2 groups 58 patients aged at least 7 years who had undergone laparoscopic appendectomy. One group, ie, the treatment group, received cold therapy in addition to standard postoperative analgesia. The cold therapy was supplied by a modified ice machine system attached to a pad that was filled with ice chips and water and applied to patients’ abdomens. At discharge, patients and their parents went home with the device and instructions about how to use it for the next 2 postoperative days (PODs). The other group, i.e. the control group, received only the standard postoperative analgesia: intravenous narcotics for the first 4 hours after surgery, followed by postoperative analgesia that included a combination of non-narcotic and narcotic medication.

Investigators surveyed participants in both groups on 3 categories of postoperative pain: overall pain, the effect of pain when walking or moving around, and the effect of pain when sleeping at night. Median overall postoperative pain scores in all 3 categories did not differ significantly between the 2 groups for any of the 3 PODs. The 2 groups also did not differ as to the need for narcotics, nor on the proportion of patients who took acetaminophen and ibuprofen or who no longer required acetaminophen or ibuprofen on POD 3. Both groups had similar rates of postoperative diet tolerance and superficial wound infection.

Despite these similarities between the 2 groups, most of those in the treatment group indicated on a survey they completed on POD 3 that they viewed the cold therapy positively and would recommend it to a friend who was having a similar surgery. Further, when asked what intervention from a list of possibilities contributed to improvement in postoperative pain, 71% selected cold therapy for POD 1, along with 74% and 50% for PODs 2 and 3, respectively.

THOUGHTS FROM DR FARBER

I would have liked for this to help, but it did not reduce the need for medication (opioid use in both groups was minimal anyway), even though patients seemed to like it. Bottom line: It should be safe (there is a potential for freeze burns if misapplied), so patients are welcome to try it.

Reference:

Scalise PN, Koo DC, Durgin JM, et al. Cold therapy for pain control in pediatric appendectomy patients: a randomized controlled trial. J Pediatr Surg. 2024;59(7):1304-1308. doi:10.1016/j.jsurg.2024.02.036