Continuous Cryotherapy vs Ice Following Total Shoulder Arthroplasty: A Randomized Control Trial
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.
STATISTICAL METHOD
The Wilcoxon rank-sum test was used to assess whether scores changed significantly from the preoperative period to the different postoperative time intervals, as well as to assess the values for pain, quality of sleep, and patient satisfaction. P-values <.05 were considered significant.
RESULTS
No differences were observed in the baseline characteristics between the 2 groups. Both groups showed improvements in pain, quality of sleep, and satisfaction with the cold therapy from the preoperative period to the final follow-up.
The VAS pain scores were not different between the CC and ICE groups preoperatively (5.9 vs 6.8; P = .121) or postoperatively 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). Both cohorts demonstrated improved overall pain throughout the study period. These findings are summarized in Table 2.
Table 2. Summary of VAS Pain Scores With Cold Therapy
CC group (mean ± SD) | ICE group (mean ± SD) | P value | 95% CI | |
Preoperative | 5.9 ± 4.1 | 6.8 ± 5.3 | .121 | 3.3-8.3 |
24 hours | 4.2 ± 3.0 | 4.3 ± 3.1 | .989 | 2.9-5.7 |
3 days | 4.8 ± 2.7 | 4.7 ± 3.2 | .944 | 3.2-6.3 |
7 days | 2.9 ± 1.8 | 3.3 ± 2.5 | .593 | 2.1-4.4 |
14 days | 2.5 ± 2.1 | 2.7 ± 1.8 | .742 | 1.5-3.6 |
Abbreviations: CC, continuous cryotherapy; CI, confidence interval; ICE, plain ice; VAS, visual analog scales.
The number of morphine equivalents of pain medication was not different between the CC and ICE groups postoperatively at 24 hours (43 vs 38 mg; P = .579), 3 days (149 vs 116 mg; P = .201), 7 days (308 vs 228 mg; P = .181), or 14 days (431 vs 348 mg; P = .213). Both groups showed increased narcotic consumption from 24 hours postoperatively until the 2-week follow-up. Narcotic consumption is summarized in Table 3.
Table 3. Summary of Narcotic Consumption in Morphine Equivalents
CC group (mean ± SD) | ICE group (mean ± SD) | P value | 95% CI | |
24 hours | 43.0 ± 36.7 | 38.0 ± 42.9 | .579 | 17.9-60.1 |
3 days | 149.0 ± 106.5 | 116.3 ± 108.9 | .201 | 63.4-198.7 |
7 days | 308.1 ± 234.0 | 228 ± 258.3 | .181 | 107.1-348.9 |
14 days | 430.8 ± 384.2 | 347.5 ± 493.4 | .213 | 116.6-610.6 |
Abbreviations: CC, continuous cryotherapy; CI, confidence interval; ICE, plain ice.
VAS for quality of sleep improved in both groups from 24 hours postoperatively until the final follow-up. However, no significant differences in sleep quality were observed between the CC and ICE groups postoperatively at 24 hours (5.1 vs 4.3; P = .382), 3 days (5.1 vs 5.3; P = .601), 7 days (6.0 vs 6.7; P = .319), or 14 days (6.5 vs 7.1; P = .348). The VAS scores for sleep quality are reported in Table 4.
Table 4. Summary of VAS Sleep Quality With Cold Therapya
CC group (mean ± SD) | ICE group (mean ± SD) | P value | 95% CI | |
24 hours | 5.1 ± 2.8 | 4.3 ± 2.4 | .382 | 3.2-6.4 |
3 days | 5.1 ± 1.9 | 5.3 ± 2.3 | .601 | 4.2-6.5 |
7 days | 6.0 ± 2.3 | 6.7 ± 2.1 | .319 | 4.9-7.7 |
14 days | 6.5 ± 2.3 | 7.1 ± 2.5 | .348 | 5.3-8.4 |
a0-10 rating with 10 being the highest possible score.
Abbreviations: CC, continuous cryotherapy; CI, confidence interval; ICE, plain ice; VAS, visual analog scales.
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