Ice-Pop
Description
Study Objective: To evaluate the benefit of ice packs as a supplement to standard pain management following laparoscopic hysterectomy. Design: This IRB approved randomized control trial involved patients undergoing laparoscopic hysterectomy (LH) for benign conditions. Subjects were randomized to receive standard enhanced recovery after surgery (ERAS) pain management or standard ERAS plus ice packs. Setting: 2 academic tertiary care centers Patients: Patients undergoing planned outpatient LH with the minimally invasive gynecologic surgery team between February 2019 and November 2020 were considered. Patients with chronic pain, current opioid use >1 week, or planned overnight hospitalizations were excluded. Primary outcome data was available for 51 subjects (24 control, 27 intervention) Interventions: Ice packs were placed on the abdomen in the operating room Measurements and Main Results: Pain was assessed at multiple time points throughout the study using Visual Analogue Scale (VAS). Narcotic requirement was assessed using morphine milligram equivalent (MME). There was no difference between the groups’ demographic data. MME requirements were not different between the groups (p=.63). Postoperative day 1 (POD#1) VAS scores were not different (p=.89). 84.8% of subjects felt their pain was controlled. Subjects that did not feel their pain was controlled did not use more narcotics POD#1 (p=.37), nor did they have higher POD#1 VAS scores (p=.55). 87% of intervention subjects would use ice again and 82.6% would recommend ice to others. There were no adverse events related to ice. All subjects were prescribed 20 tablets oxycodone and averaged 2.9 (SD 3.4) tablets used after discharge. Conclusion: Ice packs are an acceptable supplement for postoperative pain control, but do not impact postoperative narcotic usage. Providers caring for postoperative patients should be cognizant of unintentional consequences associated with overprescribing opioids and consider reducing the number prescribed given consistent evidence that patients require less than half the quantity given.