Comparison of Analgesic Efficacy of Cooling Spray and Saline Spray in Wrist Trauma; Randomized Controlled Double Blind Study
Öz
Background: Cooling spray application is commonly used in sports injuries to manage acute pain and reduce tissue edema. However, its effectiveness in treating acute trauma in the emergency department remains understudied. This prospective randomized controlled trial assessed the efficacy of cooling spray for pain management in patients with wrist injuries.
Methods: A randomized trial was conducted in a tertiary care hospital's trauma department. Patients with wrist trauma were assigned to cooling spray or placebo (saline spray) groups. Cooling spray was Cryos®Spray (Phyto Performance, Italy), while placebo was chilled saline in an identical bottle. Pain scores and radiographic images were evaluated.
Results: In 131 patients (mean age: 35.60±19.58 years, 26.7% fractures), cooling spray (n=73) yielded a delta pain score of 1.74±1.88, while saline (n=58) had 0.84±1.54 (p=0.003). For fracture patients, cooling spray's delta score was 2.26±1.88, compared to saline's 0.0±0.96 (<0.001). Non-fracture patients showed similar efficacy between cooling spray (1.55±1.85) and saline (1.16±1.60, p=0.258). Logistic regression indicated cooling spray reduced pain 1.174 times more effectively than saline.
Conclusions: Cooling sprays demonstrated superior acute pain control, notably in fractures, outperforming the placebo. Similar efficacy was observed in non-fracture cases.
Anahtar Kelimeler
Kaynakça
- 1. Kerkhoffs GM, van den Bekerom M, Elders LA, et al. Diagnosis, treatment, and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46(12):854-860. doi:10.1136/bjsports-2011-090490
- 2. Walenkamp MM, Bentohami A, Slaar A, et al. The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for using radiography in acute wrist trauma. BMC Musculoskelet Disord. 2015;16:389. Published 2015 Dec 18. doi:10.1186/s12891-015-0829-2
- 3. Park YH, Song JH, Kim TJ, Kang SH, Chang AS, Kim HJ. Comparison of the use of evaporative coolants and ice packs for managing preoperative edema and pain in ankle fractures: a prospective randomized controlled trial. Arch Orthop Trauma Surg. 2019;139(10):1399-1405. doi:10.1007/s00402-019-03222-7
- 4. Pontes-Silva A, Lima KDS, Anselmo-E-Silva CI, Lopes AL, Santos-de-Araújo AD. Comments on "Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial." Rev Assoc Med Bras (1992). 2023;69(5):e20230091. Published 2023 May 19. doi:10.1590/1806-9282.20230091
- 5. Schnell HM, Zaspel JG. Cooling extensive burns: Sprayed coolants can improve initial cooling management - a thermography-based study. Burns. 2008;34(4):505-508. doi:10.1016/j.burns.2007.06.012
- 6. ÖZCAN N,KARAGÖZOĞLU Ş Effects of Progressive Muscle Relaxation Exercise, Cold Application and Local Anesthesia Performed Before Chest Tube Removal on Pain and Comfort Levels and Vital Sings of the Patient. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2020; 40(3): 285 - 296. 10.5336/medsci.2019-72505
- 7. Kara, H., Bayir, A., Ak, A., Akinci, M., Tufekci, N., Degirmenci, S., & Azap, M. (2014). Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: A retrospective study. Clinical Interventions in Aging, 9, 17-21. Doi: 10.2147/CIA.S56542
- 8. Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage. 1994;9(1):56-59. doi:10.1016/0885-3924(94)90150-3
- 9. Işik, Meryem T., Gürsel Öztunç. "Effects of subcutaneous injectıon after coolant spray on pain, hematoma, and ecchymosıs in three different regions." Nursing Forum. Vol. 57. No. 3. 2022. Doi: 10.1111/nuf.12688
- 10. Akbaş İ, Dogruyol S, Kocak AO, et al. Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial. Rev Assoc Med Bras (1992). 2023;69(1):30-36. Published 2023 Feb 17. doi:10.1590/1806-9282.20220048
- 11. Gur STA, Dogruyol S, Kocak AO, et al. Comparison of effectiveness coolant spray and placebo in patients with acute ankle trauma prospective randomized controlled trial. Am J Emerg Med. 2020;38(7):1458-1462. doi:10.1016/j.ajem.2019.12.054
El Bileği Travmasında Soğutma Spreyi ve Salin Spreyin Analjezik Etkinliğinin Karşılaştırılması; Randomize Kontrollü Çift Kör Çalışma
Öz
Amaç: Soğutma spreyi uygulaması akut ağrıyı kontrol etmek ve doku ödemi ile başa çıkmak için genellikle spor yaralanmalarında kullanılır. Ancak, acil serviste akut travmanın tedavisindeki etkinliği yetersiz bir şekilde araştırılmıştır. Bu prospektif randomize kontrollü çalışma, bilek yaralanması olan hastalarda ağrı yönetiminde soğutma spreyinin etkinliğini değerlendirdi.
Gereç Yöntem: Bir üçüncü basamak hastanenin travma bölümünde randomize bir deneme yapıldı. Bilek travması olan hastalar soğutma spreyi veya plasebo (salin spreyi) gruplarına ayrıldı. Soğutma spreyi Cryos®Spray (Phyto Performance, İtalya) olarak kullanıldı, plasebo ise aynı görünüme sahip soğutulmuş bir salin şişesiydi. Ağrı skorları ve radyografik görüntüler değerlendirildi.
Bulgular: 131 hastada (ortalama yaş: 35.60±19.58 yıl, %26.7 kırık), soğutma spreyi (n=73) 1.74±1.88 delta ağrı skoru üretirken, salin (n=58) 0.84±1.54 (p=0.003) değerini verdi. Kırık hastalar için soğutma spreyinin delta skoru 2.26±1.88 iken salin grubunda 0.0±0.96 olarak saptandı (<0.001). Kırık olmayan hastalarda soğutma spreyinin (1.55±1.85) ve salinin (1.16±1.60, p=0.258) benzer etkinlik gösterdiği görüldü. Lojistik regresyon, soğutma spreyinin ağrıyı salin grubuna göre 1.174 kat daha etkili bir şekilde azalttığını gösterdi.
Tartışma: Soğutma spreyleri plaseboyu aşan akut ağrı kontrolü sağladı, özellikle kırıklarda daha başarılı oldu. Kırık olmayan vakalarda benzer etkinlik gözlendi.
Anahtar Kelimeler
Kaynakça
- 1. Kerkhoffs GM, van den Bekerom M, Elders LA, et al. Diagnosis, treatment, and prevention of ankle sprains: an evidence-based clinical guideline. Br J Sports Med. 2012;46(12):854-860. doi:10.1136/bjsports-2011-090490
- 2. Walenkamp MM, Bentohami A, Slaar A, et al. The Amsterdam wrist rules: the multicenter prospective derivation and external validation of a clinical decision rule for using radiography in acute wrist trauma. BMC Musculoskelet Disord. 2015;16:389. Published 2015 Dec 18. doi:10.1186/s12891-015-0829-2
- 3. Park YH, Song JH, Kim TJ, Kang SH, Chang AS, Kim HJ. Comparison of the use of evaporative coolants and ice packs for managing preoperative edema and pain in ankle fractures: a prospective randomized controlled trial. Arch Orthop Trauma Surg. 2019;139(10):1399-1405. doi:10.1007/s00402-019-03222-7
- 4. Pontes-Silva A, Lima KDS, Anselmo-E-Silva CI, Lopes AL, Santos-de-Araújo AD. Comments on "Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial." Rev Assoc Med Bras (1992). 2023;69(5):e20230091. Published 2023 May 19. doi:10.1590/1806-9282.20230091
- 5. Schnell HM, Zaspel JG. Cooling extensive burns: Sprayed coolants can improve initial cooling management - a thermography-based study. Burns. 2008;34(4):505-508. doi:10.1016/j.burns.2007.06.012
- 6. ÖZCAN N,KARAGÖZOĞLU Ş Effects of Progressive Muscle Relaxation Exercise, Cold Application and Local Anesthesia Performed Before Chest Tube Removal on Pain and Comfort Levels and Vital Sings of the Patient. Türkiye Klinikleri Tıp Bilimleri Dergisi. 2020; 40(3): 285 - 296. 10.5336/medsci.2019-72505
- 7. Kara, H., Bayir, A., Ak, A., Akinci, M., Tufekci, N., Degirmenci, S., & Azap, M. (2014). Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: A retrospective study. Clinical Interventions in Aging, 9, 17-21. Doi: 10.2147/CIA.S56542
- 8. Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage. 1994;9(1):56-59. doi:10.1016/0885-3924(94)90150-3
- 9. Işik, Meryem T., Gürsel Öztunç. "Effects of subcutaneous injectıon after coolant spray on pain, hematoma, and ecchymosıs in three different regions." Nursing Forum. Vol. 57. No. 3. 2022. Doi: 10.1111/nuf.12688
- 10. Akbaş İ, Dogruyol S, Kocak AO, et al. Effect of coolant spray on rib fracture pain of geriatric blunt thoracic trauma patients: a randomized controlled trial. Rev Assoc Med Bras (1992). 2023;69(1):30-36. Published 2023 Feb 17. doi:10.1590/1806-9282.20220048
- 11. Gur STA, Dogruyol S, Kocak AO, et al. Comparison of effectiveness coolant spray and placebo in patients with acute ankle trauma prospective randomized controlled trial. Am J Emerg Med. 2020;38(7):1458-1462. doi:10.1016/j.ajem.2019.12.054
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp, Ağrı |
| Bölüm | Orjinal Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2023 |
| Kabul Tarihi | 7 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 13 Sayı: 5 |
