The different ice pack therapy durations would cause similar discomfort incidence rates in the three groups. Ice pack therapy for 10 minutes could reduce partial swelling and pain effectively. Accordingly, we suggest that 10 minutes is the optimal ice pack therapy duration for persons with soft tissue injuries. However, the ice pack therapy duration should be adjusted according to individual needs and situation.
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Create File. Twenty-eight other variables were also examined, but no significant differences were found between groups. Based on these results, the authors stated that they can not recommend continuous cold therapy or justify the extra expense for all patients who undergo TKA. The benefits of this type of device above other cooling or heating methods have not been established at this time. It provides heating, cooling and compression therapies. The device also includes a deep vein thrombosis DVT mode -- this is a compression or air only mode, that is intended to prevent DVT.
It is limited to a cold temperature of 49 degrees F to minimize the potential for frostbite. However, it provides no additional clinical utility or impact on health outcomes than the use of ice or compression wraps. Continuous cold is delivered by a solid-state system without ice. Intermittent compression is delivered distal-to-proximal through a segmented pad. Deep vein thrombosis prophylaxis is delivered from a rapid inflation pump at 50 mm Hg through a calf pad or mm Hg through a foot pad. All 3 therapies are delivered separately, however cold-compression and DVT compression can run at the same time with the device cycling DVT compression separate from limb compression.
However, there is a lack of evidence regarding the safety and effectiveness of this device.
Hot and Cold Packs: A Thermochemistry Activity
The system is pre-programmed per written physician's instructions for fully automatic, safe, trouble-free use in the patient's home. It is indicated for pain, edema, and DVT prophylaxis for the post-operative orthopedic patient. The precisely controlled temperature range of 43 degrees F to degrees F insures against frost-bite or burns.
Therapy times are also pre-programmed to insure maximum patient compliance. It is extremely easy for patients to set up and use. In a systematic review, Raggio and colleagues examined the effectiveness of intra-operative cryoanalgesia in the management of post-operative pain among patients undergoing palatine tonsillectomy.
They included English-language RCTs evaluating patients of all age groups with benign pathology who underwent tonsillectomy with cryoanalgesia versus without.
A total of 3limited quality RCTs involving participants age range of 1 to 60 years were included. In the 3 trials reviewed, patients who received cryoanalgesia reported Review of secondary outcomes suggested no significant difference in time to resume normal diet 2 studies or post-operative bleeding 2 studies between the 2 groups. Cryoanalgesia allowed patients to return-to-work 4 days earlier than controls in 1 study; 2 studies reported a trend toward less post-operative analgesia use among the treatment group; however, no statistical conclusions could be drawn.
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The authors concluded that available evidence suggested that patients undergoing tonsillectomy with cryoanalgesia experienced less average post-operative pain without additional complications. These preliminary findings need to be validated by well-designed studies. Cooper and colleagues stated that after severe traumatic brain injury TBI , induction of prophylactic hypothermia has been suggested to be neuro-protective and improve long-term neurologic outcomes.
These researchers examined the effectiveness of early prophylactic hypothermia compared with normothermic management of patients after severe TBI. The first patient was enrolled on December 5, , and the last on November 10, The final date of follow-up was May 15, There were patients randomized to the prophylactic hypothermia group and to normothermic management.
Temperature was managed in both groups for 7 days. All other care was at the discretion of the treating physician. The primary outcome was favorable neurologic outcomes or independent living Glasgow Outcome Scale-Extended score, 5 to 8 [scale range of 1 to 8] obtained by blinded assessors 6 months after injury. Among patients who were randomized, provided ongoing consent mean age of Hypothermia was initiated rapidly after injury median of 1. Favorable outcomes Glasgow Outcome Scale-Extended score, 5 to 8 at 6 months occurred in patients In the hypothermia and normothermia groups, the rates of pneumonia were The authors concluded that among patients with severe TBI, early prophylactic hypothermia compared with normothermia did not improve neurologic outcomes at 6 months.
These findings did not support the use of early prophylactic hypothermia for patients with severe TBI. Guidelines on management of severe traumatic brain injury from the Brain Injury Foundation Carney, et al. Choi and associates noted that therapeutic hypothermia TH improves the neurological outcome in patients after cardiac arrest and neonatal hypoxic brain injury. In a pilot study, these researchers studied the safety and feasibility of mild TH in patients with poor-grade subarachnoid hemorrhage SAH after successful treatment. Patients were allocated randomly to either the TH group A total of 11 patients received TH for 48 hours followed by 48 hours of slow re-warming.
Vasospasm, delayed cerebral ischemia DCI , functional outcome, mortality, and safety profiles were compared between groups. In the TH group, 10 of 11 At 3 months, Mortality at 1 month was Furthermore, it may reduce the risk of vasospasm and DCI, improving the functional outcomes and reducing mortality.
Moreover, these researchers stated that larger randomized controlled studies should be conducted to determine the safety and clinical impact of TH in poor-grade SAH patients following successful intervention. The authors stated that this study had several drawbacks. First, this was a pilot study and should be interpreted with caution. A larger sample size may be needed to identify a meaningful difference between TH and control groups.
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Third, despite well-designed neuro-critical care treatment guidelines, a hidden bias may exist between TH and control groups in critical care because the treating physicians were not double-blinded. Fourth, the induction time of TH was confined after successful intervention. Fifth, the different use of cooling devices was not reflected in TH group. Yao and colleagues stated that TH has shown good results in experimental models of hemorrhagic stroke.
The clinical application of TH, however, remains controversial, since reports regarding its therapeutic effect were inconsistent. The subgroup analyses were stratified by study type, country, mean age, hemorrhage type, cooling method, treatment duration, rewarming velocity, and follow-up time. A total of 9 studies were included, most of which were of moderate quality. The overall effect demonstrated insignificant differences in mortality risk ratio [RR] 0.
Hot and Cold Packs: A Thermochemistry Activity | taira-kousan.com
However, sensitivity analyses, after omitting 1 study, achieved a statistically significant difference in poor outcome favoring TH. Moreover, in the subgroup analyses, the results derived from randomized studies revealed that TH significantly reduced poor outcomes RR 0. The incidence of specific complications re-bleeding, pneumonia, sepsis, arrhythmia, and hydrocephalus between the 2 groups were comparable and did not reach significant difference.
The authors concluded that the overall effect showed TH did not significantly reduce mortality and poor outcomes but led to a decreased incidence of DCI. Compared with control, TH resulted in comparable incidences of specific complications. Review History. Clinical Policy Bulletin Notes. Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. Cryoanalgesia and Therapeutic Cold. Print Share. Background Cryoanalgesia for Trigeminal Neuralgia Trigeminal neuralgia TN , also known as tic douloureux, is a disorder characterized by excruciating episodic pain in the areas innervated by one or more divisions usually the mandibular and maxillary, rarely the ophthalmic divisions of the trigeminal nerve.
Humble et al noted that peri-operative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the peri-operative period with the potential to reduce the risk of chronic pain. These investigators performed a systematic review of the evidence for peri-operative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy.
A total of 32 randomized controlled trials RCTs met the inclusion criteria.
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Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre-existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and peri-operative EMLA eutectic mixture of local anesthetic cream reduced the incidence of chronic pain after mastectomy, whereas local anesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms.
Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anesthesia TIVA reduced the incidence of post-thoracotomy pain in 1 study, whereas high-dose remifentanil exacerbated chronic pain in another. The authors concluded that appropriate dose regimes of gabapentinoids, anti-depressants, local anesthetics and regional anesthesia may potentially reduce the severity of both acute and chronic pain for patients; ketamine was not effective at reducing chronic pain; intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain; and TIVA may be beneficial but the effects of opioids are unclear.
The pump automatically exchanges water from the pump to the cooler and eliminates the need for manual water recycling. Hilotherm - Heat and cold water pump with pads.