Efficacy of the Game Ready® cooling device on postoperative analgesia after scoliosis surgery in children

Cryo-Pneumatic Compression Results in a Significant Decrease in Opioid Consumption After Shoulder Surgery: A Multicenter Randomized Controlled Trial

BACKGROUND

The management of pain after shoulder surgery typically includes the use of cryotherapy and the prescription of opioid analgesics. Much focus has been placed lately on the opioid epidemic, which in part is fueled by excessive prescription of opioid medication. Previous studies have found a combination of cryotherapy and compression effective at reducing analgesic consumption and increasing recovery in patients undergoing knee and spine surgery; however, efficacy in patients undergoing shoulder surgery has not been evaluated.

PURPOSE

To evaluate the effectiveness of a cryo-pneumatic compression device on postoperative shoulder pain, narcotic use, and quality of life when compared with standard care cryotherapy.

STUDY DESIGN

Randomized controlled trial; Level of evidence, 2.

METHODS

In total, 200 patients older than 18 years scheduled for unilateral shoulder surgery were enrolled. Patients were randomized to receive either postoperative cryo-pneumatic compression or standard care. The intervention group received a cryo-pneumatic device, while the standard care group received the treating surgeon's preferred method of postoperative care, including standard cryotherapy. Narcotic use was evaluated by the number of oral morphine milligram equivalents consumed during the postoperative period, as well as the time to cessation of narcotic use. Patient-reported outcome measures consisted of a numeric rating scale pain score, 36-item Short Form Survey, patient experience assessed using the net promoter score, and adverse events. Outcomes were evaluated at 2, 6, and 12 weeks postoperatively.

RESULTS

Patients receiving cryo-pneumatic compression reported a significant decrease in opioid consumption when compared with standard care (oral morphine milligram equivalents median, 56.1 vs 112; P = .02468). A significant increase in self-reported function was seen in the cryo-pneumatic compression group at 2 weeks when compared with standard care (mean, 61.2 vs 54.2; P = .0412).

CONCLUSION

In patients undergoing unilateral shoulder surgery, the use of cryotherapy with pneumatic compression, when compared with standard care, resulted in significantly decreased opioid consumption as well as increased function at 2 weeks.

REGISTRATION

NCT04185064 (ClinicalTrials.gov identifier).

Cold for centuries: a brief history of cryotherapies to improve health, injury and post-exercise recovery

For centuries, cold temperatures have been used by humans for therapeutic, health and sporting recovery purposes. This application of cold for therapeutic purposes is regularly referred to as cryotherapy. Cryotherapies including ice, cold-water and cold air have been popularised by an ability to remove heat, reduce core and tissue temperatures, and alter blood flow in humans. The resulting downstream effects upon human physiologies providing benefits that include a reduced perception of pain, or analgesia, and an improved sensation of well-being. Ultimately, such benefits have been translated into therapies that may assist in improving post-exercise recovery, with further investigations assessing the role that cryotherapies can play in attenuating the ensuing post-exercise inflammatory response. Whilst considerable progress has been made in our understanding of the mechanistic changes associated with adopting cryotherapies, research focus tends to look towards the future rather than to the past. It has been suggested that this might be due to the notion of progress being defined as change over time from lower to higher states of knowledge. However, a historical perspective, studying a subject in light of its earliest phase and subsequent evolution, could help sharpen one's vision of the present; helping to generate new research questions as well as look at old questions in new ways. Therefore, the aim of this brief historical perspective is to highlight the origins of the many arms of this popular recovery and treatment technique, whilst further assessing the changing face of cryotherapy. We conclude by discussing what lies ahead in the future for cold-application techniques.

Enhanced recovery after lumbar fusion surgery: Benefits of using Game Ready©

INTRODUCTION

The primary aim of this study was to evaluate how the Game Ready© cryotherapy system impacts postoperative analgesia following lumbar fusion. The secondary aim was to study the effect of cryotherapy on blood loss, transfusion rate and recovery after surgery.

MATERIALS AND METHODS

This was a retrospective study of 60 patients divided into two consecutive sets. The first set of 30 patients underwent the current anesthesia protocol at our facility (control group) while the second set of 30 underwent the same protocol but the patient wore the Game Ready© cryotherapy belt immediately postoperative (GR group).

RESULTS

VAS for pain at H6 did not differ between groups [5.2±1.7 vs. 5.2±1.8 (p=0.94)]; however, there was a significant decrease in pain at H24 and H48 in the GR group relative to the control group (p=0.04; p=0.01; p=0.01). Consumption of morphine over the first 24 and 48hours was 50% less in the GR group than in the control group (p=0.01 and p<0.0001). Discharge occurred significantly earlier in the GR group (3.9±1.0 days) than the control group (5.1±0.9 days) (p<0.001). The estimated blood loss was greater in the control group than the GR group (574.7ml±339.2 vs. 305.9ml±229.6; p=0.0003).

CONCLUSION

Use of a cryotherapy device in the context of spine surgery is effective at controlling postoperative pain. It also decreases the consumption of analgesics, limits blood loss, reduces the need for transfusions, and contributes to enhanced recovery after surgery.

LEVEL OF EVIDENCE

IV.