P2D318: Cold Therapy for Pain Control in Pediatric Appendectomy Patients: A Randomized Controlled Trial

Background: Appendicitis is the most common acute surgical condition in children. Topical ice has been shown to reduce pain scores and opioid use in adults with midline abdominal incisions. We designed a topical cold therapy system using a modified orthopedic cold compression device to allow controlled continuous cold therapy over postoperative incisions. This study was designed to evaluate the efficacy of a cold therapy system following laparoscopic appendectomy in children.

Methods: Patients aged 7 years and older who underwent laparoscopic appendectomy at a single institution from December 2021 to September 2022 were eligible for the study. Patients were randomized to receive either standard of care therapy (control) versus standard of care plus cold therapy (treatment) utilizing a modified cold compression system. The Breg Polar Care CubeTM is FDA approved and used routinely after orthopedic surgery; the device was filled with ice chips and water per manufacturer instructions, and a barrier towel was wrapped around the WrapOn Polar Pad before applying to the abdomen (Figure 1). Patients were sent an app-based survey on the first 3 postoperative days (PODs). The primary outcome of pain relief was assessed with the 10-point Numeric Pain Intensity Scale; secondary outcomes included postoperative narcotic use, hospital length of stay, and patient satisfaction.

Results: A total of 58 patients were randomized: 29 each to the control and treatment groups. The average survey response rate was 74% in control and 89% in treatment patients. No significant differences in gender, age, weight, prior abdominal surgeries, amount of local anesthetic received, or incidence of perforation existed between groups. Patients in the cold therapy group reported that they used the device for a median of 7-12 hours/day on PODs 1-2 and 1-6 hours/day on POD3.

There was no significant difference in median pain scores on PODs 1-3 or postoperative narcotic use, as measured by morphine milliequivalents (MME), between the groups (Table 1). Seven control and six treatment cases were admitted postoperatively, with the remainder being discharged home with the device. Sub-analysis of perforated cases was limited by sample size (5 control and 2 treatment cases). Cold therapy patients overall viewed the treatment positively, with a median recommendation score of 9.5 on a 10-point scale (IQR 7.5-10). When surveyed on which factors contributed to improvement in postoperative pain, cold therapy was selected by 71%, 74%, and 50% of respondents on PODs 1, 2, and 3 respectively.

Conclusion: The majority of patients and families reported that cold therapy was a helpful adjunct in pain control after appendectomy, though it did not significantly reduce postoperative pain scores or narcotic use in our cohort. This is likely due to low baseline narcotic requirement and expedient hospital discharge in this population.