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A Cold World: Pain Outcomes and Patient Experiences Utilizing an Iceless Cold Compression System after Hand Surgery
Brian T Ford, MD; Seema Patel, BS; Dillon Neumann, MD; Lisa Tamburini, MD; Fran Zeng, MD; Anthony Parrino, MD
University of Connecticut, Farmington, CT
Introduction: We hypothesized that an iceless cold compression system placed prior to splint application in postop patients who undergo hand or elbow surgery is a helpful adjunct in pain control. We believed it would confer better pain control than simply applying ice packs over a splint.
Materials and Methods:This was a retrospective review of patients operated on by a single hand surgeon from February 2023-March 2024, evaluating their experiences and pain-related outcomes with one of two postop cold therapy regimens. After surgery all patients had a splint applied to their upper extremity. One cohort was the cold therapy device (CTD) group, who had a flexible iceless cold compression system placed over their operative site prior to splint application (
Figure 1). The other cohort was the non-CTD group, who did not have a cold flow device but were rather instructed to apply ice over their splint as needed. Surveys were administered to patients at their first postop visit 1-2 weeks after surgery. Comparative analysis was performed.
Results:60 patients were observed in the CTD group and 17 in the non-CTD (ice pack) group. The most common procedures within the CTD and the non-CTD cohorts included CMC arthroplasty (33.3% vs. 47.1%, respectively) and distal radius ORIF (30.0% vs. 23.5%). When the CTD cohort was asked to rate their overall postop pain relief satisfaction on a 0-10 scale (0=least; 10=most), the average rating was 9.42 (95% CI: 8.96-9.87)(
Table 1). The CTD group's devices contributed significantly more to alleviating their postop pain (9.13 [0-10 scale]) than the non-CTD cohort felt that ice packs helped (3.11; p<0.001). In regards to frequency of cold therapy use, the CTD group used their devices more days (90.0% of patient with >7 days use) than the non-CTD group used ice packs (0 patient with >7 days use; p<0.001). On days when cold therapy was employed, 41/60 (68.33%) of patients in the CTD group used their devices >7 sessions/day, compared to 1/17 (5.88%) of patients in the non-CTD that used ice packs >7 sessions/day. In regards to postop narcotic use, there was a trend toward significance of the CTD group taking less narcotics than the non-CTD group (8.21 vs. 11.09 pills; p=0.097).
Conclusion:Cold therapy devices are a useful adjunct in pain control in upper extremity surgeries. They alleviated pain better than ice packs alone, and may be associated with less narcotic use, although this needs further exploration.
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