Abdominal Ice Packs for Pain Control and Reduction of Narcotic Use Following Laparoscopic Hysterectomy

Hysterectomy is one of the most common surgical procedures performed on women in the United
States, with approximately 600,000 performed annually. The use of postoperative cooling as an
adjuvant for post-operative pain control has previously been shown to be effective and safe
in a variety of procedures, but has yet to be described for laparoscopic surgery. In contrast
to laparotomy where the wound is a significant pain generator and direct application of ice
is intuitive, in laparoscopic surgery much of the pain-generating tissue trauma is
intraperitoneal and pelvic in nature, away from the abdominal wall. Ice pack use on the
abdominal wall likely inhibits visceral afferent pain fibers via somatic afferent nerve
cross-talk. Accordingly, applying ice to the abdominal wall and its somatic afferents may
improve laparoscopic pain control, despite the lack of a significant abdominal wound. Our
goal is to quantify narcotic use after hospital discharge following hysterectomy, and
evaluate the effectiveness of abdominal ice packs as low cost adjuncts for pain control.

Inclusion Criteria:

- Women undergoing robotic or conventional laparoscopic hysterectomy

Exclusion Criteria:

- Any opioid use within 2 weeks of surgery date

- Planned post-operative ICU admission

- Conversion of laparoscopic approach to laparotomy or any incision ≥4 cm

- Regional anesthesia/analgesia, including tap block use