Library: Article

Title: Ice-packs, frozen peas or GameReady? What, how and why
Date: 7/1/10

Detail: Cryotherapy, or the use of cold temperature as a treatment modality, has been utilized for centuries to control pain and inflammation following injury or surgery. Historically, and contemporarily, ice-cubes or ice-packs have been used to cause local vasoconstriction (thereby limiting hemorrhage, edema and local inflammatory responses), slow cellular metabolism (with an associated decrease in hypoxic tissue damage) and delay local nerve conduction (effecting local analgesia). Cryotherapy can be useful in the treatment of the acute phase of inflammatory conditions such as musculotendinous strains or sprains. Importantly, the application of heat, in these situations, is detrimental in the acute phase and may result in additional vascular congestion and increased pain.

Many variations of ice-packs are used in clinical practice; including frozen vegetables, a bag of ice wrapped in a thin moist cloth, commercial freezer blocks, water mixed with isopropyl alcohol, or commercial cold-packs. Importantly, the barrier between ice and skin must be thick enough to prevent burns, but thin enough to allow effective cold conduction. While this this barrier allows cooling of the soft tissues, it also allows warming of the ice by the patient; thus limiting the consistency and duration of effective treatment. Further, ice-cooling is not conducted through padded elastic bandages. With post-operative cryotherapy being the most common treatment scenario, a dilemma presents between immediate post-operative bandage compression to decrease hematoma and edema formation, and effective cooling with cryotherapy.

Veterinary Surgical Centers has recently solved this dilemma with the addition of GameReady both the PETS-Berkeley and VetCare-Dublin facilities. GameReady incorporates both a constant, temperature adjustable circulating water bandage with a constant-or-oscillating, hydraulic compression bandage. The combination of time, temperature and pressure are all variable and tailored to the individual.

Our current treatment recommendations are to apply cryotherapy immediately after surgery while under anesthesia or during anesthetic recovery. Therapy is combined with intermittent, oscillating compression; discontinued or postponed if the patient's temperature is below 98 degrees Fahrenheit (37 degrees Celsius); and continued for 20 minutes, every 4 hours while the patient is hospitalized. No recommended target tissue temperature has been established, and different individuals tolerate different regimens, therefore each patient is constantly monitored for discomfort.

Since instituting GameReady, have been impressed with the lack of post-operative soft-tissue swelling. This is encouraging, considering that we have not regularly applied compressive bandages on these cases.