Ice Pack Test Eased Ptosis in a Patient Presenting with a Possible Oculomotor Nerve Schwannoma: A Case Report

A 32-year-old man presented with complete third nerve palsy. Brain magnetic resonance imaging revealed a possible sporadic oculomotor nerve schwannoma in the left cavernous sinus. Interestingly, the patient’s ptosis was fluctuating and eased immediately after application of ice over his eyelid. The ice pack test (IPT) is a simple and fast method that can help diagnose myasthenia gravis (MG) in patients with ptosis. Additional diagnostic investigations (antibody assays and repetitive stimulation) excluded associated MG in the patient. Tumor treatment with Gamma Knife radiosurgery was planned. This case highlights the finding that IPT can also be positive in neurogenic (non-myasthenic) ptosis, but its usefulness in other disorders associated with muscle weakness and fatigability remains questionable.

Effect of different cold application materials on pain during chest tube removal: three-arm randomized controlled clinical trial

Background: Chest tube causes severe pain during removal because it attaches to the endothelium in the chest cavity. Objectives: This study aimed to determine the effectiveness of cold application with ice pack and gel pad in the control of pain experienced during chest tube removal. Methods: The sample of prospective, parallel three-arm (1:1:1), randomized controlled clinical trial consisted of 180 patients in two experimental groups (ice pack/gel pad) and one control group. The primary outcome was effect of cold application materi- als on severity of pain during chest removal. Secondary outcomes were duration of cold application and analgesic requirements of the patients. Results: The study found that the cold application using either of the materials reduced the severity of pain and the need for analgesics after the removal of chest tube compared to the control group (p<0.05). But cold application with ice pack allowed the skin to drop to the temperature effective in pain control in a shorter time than gel pad application (p<0.05). Conclusions: Despite entirely covering the area around the chest tube, the gel pad was more disadvantageous than ice pack in pain control due to the longer duration of cold application. Keywords: Chest tube removal; cold application; pain; nurse.

A Randomised Controlled Trial of Ice to Reduce the Pain of Immunisation—The ICE Trial

Background and objectives: vaccine injections are a common cause of iatrogenic pain and anxiety, contributing to non-compliance with scheduled vaccinations. With injection-related pain being recognised as a barrier to vaccination uptake in both adults and children, it is important to investigate strategies to effectively reduce immunisation pain. This prospective randomised controlled trial investigated the effects of applying an ice pack on vaccine-related pain in adults. Methods: medical students receiving the flu vaccination were randomised to receive an ice pack (intervention) or placebo cold pack (control) at the injection site for 30 s prior to needle insertion. Immediate post-vaccination pain (VAS) and adverse reactions in the proceeding 24 h were recorded. Results: pain scores between the intervention (n = 19) and control groups (n = 16) were not statistically significant (intervention: median pain VAS = 7.00, IQR = 18; control: median pain VAS = 11, IQR = 14 (p = 0.26). There were no significant differences in the number of adverse events between the two groups (site pain p = 0.18; localised swelling (p = 0.67); bruising p = 0.09; erythema p = 0.46). Discussion: ice did not reduce vaccination-related pain compared to cold packs. COVID-19 related restrictions impacted participant recruitment, rendering the study insufficiently powered to draw conclusions about the results.

Effectiveness of Ice Pack Application on Level of Pain and Bruise Formation among Patients Receiving Subcutaneous Low Molecular Weight Heparin at Selected Hospitals of City

Background: Bruising is one of the most common adverse events following administration of enoxaparin sodium, which can lead to unpleasant consequences such as reduced access to various sites for injection, reduced satisfaction of patients from treatment and care provided. Cold application is helpful for better management of these side effects which could be easily accessible and economical for the patients. Cold application appears to be cheaper and easily available. Aim: The purpose of this study was to identify the effectiveness of ice pack application on level of pain and bruise formation among patients receiving subcutaneous low molecular weight heparin. Method: Quasi experimental nonequivalent control group posttest only design was adopted. The population comprised of 60 patients receiving subcutaneous low molecular weight heparin from selected hospitals of Pune. Sample of the study were 60 patients receiving subcutaneous low molecular weight heparin patients selected by convenient sampling. The patients in experimental group were provided with ice pack application before receiving subcutaneous low molecular weight heparin to reduce the level of pain and bruise formation. Data was collected by using numerical pain scale, visual analog scale and transparent ruler scale. Result: The study findings showed that average numerical pain score in experimental group was 3.87 and 6.33 in control group. Bruise size was measured in cm. In experimental group Average bruise formation size was 0.0233 after 24 hours of injection, 0.1633 after 48 hours of injection and 0.1766 after 72 hours of injection compared to control group 0.2733 after 24 hours of injection, 0.3933 after 48 hours of injection and 0.4066 after 72 hours of injection. There is significant difference in mean scores of experimental and control group. Conclusion: The findings of the study shows that the ice pack application is effective in reducing the level of pain and bruise formation among patients receiving