Original Research

Continuous Cryotherapy vs Ice Following Total Shoulder Arthroplasty: A Randomized Control Trial

Publish date: June 19, 2018

TAKE-HOME POINTS

CC has been proposed as a means of improving postoperative pain control.
CC represents a cost typically not covered by insurances.
No difference was noted between the 2 groups in quality of sleep, satisfaction with the cold therapy, or narcotic usage at any time interval.
While CC may offer convenience advantages, the increased cost associated with this type of unit may not be justified.
The mechanism for CC for pain control is poorly understood.

References

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ABSTRACT

Postoperative pain management is an important component of total shoulder arthroplasty (TSA). Continuous cryotherapy (CC) has been proposed as a means of improving postoperative pain control. However, CC represents an increased cost not typically covered by insurance. The purpose of this study is to compare CC to plain ice (ICE) following TSA. The hypothesis was that CC would lead to lower pain scores and decreased narcotic usage during the first 2 weeks postoperatively.

A randomized controlled trial was performed to compare CC to ICE. Forty patients were randomized to receive either CC or ICE following TSA. The rehabilitation and pain control protocols were otherwise standardized. Visual analog scales (VAS) for pain, satisfaction with cold therapy, and quality of sleep were recorded preoperatively and postoperatively at 24 hours, 3 days, 7 days, and 14 days following surgery. Narcotic usage in morphine equivalents was also recorded.

No significant differences in preoperative pain (5.9 vs 6.8; P = .121), or postoperative pain at 24 hours (4.2 vs 4.3; P = .989), 3 days (4.8 vs 4.7; P = .944), 7 days (2.9 vs 3.3; P = .593) or 14 days (2.5 vs 2.7; P = .742) were observed between the CC and ICE groups. Similarly, no differences in quality of sleep, satisfaction with the cold therapy, or narcotic usage at any time interval were observed between the 2 groups.

No differences in pain control, quality of sleep, patient satisfaction, or narcotic usage were detected between CC and ICE following TSA. CC may offer convenience as an advantage, but the increased cost associated with this type of treatment may not be justified.

The number of total shoulder arthroplasties (TSAs) performed annually is increasing dramatically.¹ At the same time, there has been a push toward decreased length of hospital stay and earlier mobilization following joint replacement surgery. Central to these goals is adequate pain control. Multimodal pain pathways exist, and one of the safest and cheapest methods of pain control is cold therapy, which can be accomplished with continuous cryotherapy (CC) or plain ice (ICE).

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