Finally, VAS patient satisfaction scores were not different between the CC and ICE groups postoperatively at 24 hours (7.3 vs 6.1; P = .315), 3 days (6.1 vs 6.6; P = .698), 7 days (6.6 vs 6.9; P = .670), or 14 days (7.1 vs 6.3; P = .288).
While compliance within each group utilizing the randomly assigned cold modality was similar, the usage by the CC group was consistently higher at all time points recorded. No complications or reoperations were observed in either group.
DISCUSSION
The optimal method for managing postoperative pain from an arthroplasty procedure is controversial. This prospective randomized study attempted to confirm the hypothesis that CC infers better pain control, improves quality of sleep, and decreases narcotic usage compared to ICE in the first 2 weeks after a TSA procedure. The results of this study refuted our hypothesis, demonstrating no significant difference in pain control, satisfaction, narcotic usage, or sleep quality between the CC and ICE cohorts at all time points studied.
Studies on knees and lower extremities demonstrate equivocal results for the role CC plays in providing improved postoperative pain control. Thienpont10 evaluated CC in a randomized control trial comparing plain ice packs postoperatively in patients who underwent TKA. The author found no significant difference in VAS for pain or narcotic consumption in morphine equivalents. Thienpont10 recommended that CC not be used for outpatient knee arthroplasty as it is an additional cost that does not improve pain significantly. Healy and colleagues5 reported similar results that CC did not demonstrate a difference in narcotic requirement or pain control compared to plain ice packs, as well as no difference in local postoperative swelling or wound drainage. However, a recently published randomized trial by Su and colleagues11 comparing a cryopneumatic device and ICE with static compression in patients who underwent TKA demonstrated significantly lower narcotic consumption and increased ambulation distances in the treatment group. The treatment group consumed approximately 170 mg morphine equivalents less than the control group between discharge and the 2-week postoperative visit. In addition, a significant difference was observed in the satisfaction scores in the treatment group.11 Similarly, a meta-analysis by Raynor and colleagues12 on randomized clinical trials comparing cryotherapy to a placebo group after anterior cruciate ligament reconstruction showed that cryotherapy is associated with significantly lower postoperative pain (P = .02), but demonstrated no difference in postoperative drainage (P = .23) or range of motion (P = .25).
Although multiple studies have been published regarding the efficacy of cryotherapy after knee surgery, very few studies have compared CC to conventional ICE after shoulder surgery. A prospective randomized trial was performed by Singh and colleagues13 to compare CC vs no ICE in open and arthroscopic shoulder surgery patients. Both the open and arthroscopic groups receiving CC demonstrated significant reductions in pain frequency and more restful sleep at the 7-day, 14-day, and 21-day intervals compared to the control group. However, they did not compare the commercial unit to ICE. In contrast, a study by Kraeutler and colleagues8 randomized 46 patients to receive either CC or ICE in the setting of arthroscopic shoulder surgery. Although no significant difference was observed in morphine equivalent dosage between the 2 groups, the CC group used more pain medication on every postoperative day during the first week after surgery. They found no difference between the 2 groups with regards to narcotic consumption or pain scores. The results of this study mirror those by Kraeutler and colleagues,8 demonstrating no difference in pain scores, sleep quality, or narcotic consumption.
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