Evidenz-basierte Pflege am Beispiel von Kälteanwendungen nach ausgewählten orthopädischen Eingriffen – eine Literaturstudie

Abstract

Cryotherapy is often used in postoperative nursing after orthopedic surgery in order to support healing. A comprehensive literature search was executed in the databases of Medline, Cinahl and The Cochrane Library to identify meta analysis and randomised controlled trials of the application of local cooling after knee, hip, shoulder and spine surgery. The focus was on effects on pain-relief swelling, drainage, and the patients' tolerance. The findings of the 17 included articles were of variable methodological quality and in several points contradictory. Generally, solely an analgesic effect was demonstrated by the use of continuous cooling. The application of cold above 4 degrees C was considered comfortable by the patients, whereas reducing effects on swelling and drainage could not been found. Crashed ice, cold packs and electric-powered cooling devices differ in handling, effect and efficiency. Therefore, exact recommendations on application time and temperature can not be given. Furthermore, the effect of local cooling is influenced by compression and wound dressing techniques and must be considered with the application.

Acute effects of cold therapy on knee skin surface temperature: gel pack versus ice bag

“…The primary aim of cold therapy is the removal of heat energy via conduction from the site of injury, in order to facilitate a therapeutic effect 1. Cold therapy produces a number of physiological effects to the human body including a reduction in blood flow, oedema, haemorrhage,2 cellular metabolic rate, hypoxia, enzymatic activity and tissue damage 3. Cold therapy has also been demonstrated to significantly increase the pain threshold and pain tolerance by reducing nerve conduction velocity and muscle spasm 4…”

Cold versus cold compression therapy after shoulder arthroscopy: a prospective randomized clinical trial

“…Risk of damage to the skin could be excluded because time periods between changing the cold packs were long and temperature of cold packs increased over time. Furthermore, temperatures above 4 °C are perceived as comfortable by patients [6]. The bandage was fixed at the shoulder with Velcro ® straps around the upper arm and the thorax while the patient was lying in supine position.…”

“…Following surgery and injury, cooling of the operated or injured area has an analgesic effect [6]. However, cold therapy or cold compression therapy is used with controversial results.…”