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CRITICAL CARE AND TRAUMA

The Influence of Local Active Warming on Pain Relief of Patients with Cholelithiasis During Rescue Transport

Alexander Kober, MD^*, Thomas Scheck, MD^*, Freia Tschabitscher, MD^*, Stefanie Wiltschnig, MD^*, Sabine Sator-Katzenschlager, MD^*, Werner Madei, MD, Burkhard Gustorff, MD^*, and Klaus Hoerauf, MD^*

*Department of Anesthesia and Intensive Care, University of Vienna; and Department of Anesthesia, Armed Forces Medical Hospital, Amberg, Germany

Address correspondence and reprint requests to Klaus Hoerauf, MD, Department of Anesthesiology and Intensive Care, University Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to klaus.hoerauf{at}univie.ac.at

Upper abdominal pain, a frequent symptom of the presence of gallstone disease, is the cause of 6% of the emergency calls of the Austrian emergency system. Pain resulting from cholelithiasis is characteristically severe. Recent data show that active warming during emergency transport of trauma victims is effective in reducing pain. Therefore, we hypothesized that local active warming of the abdomen would be an effective pain treatment for patients with acute cholelithiasis and could be provided by paramedics. Sixty patients (>19 yr) consented to participate in this study. They were divided into two groups: Group 1, who received active warming of the upper abdomen with a carbon-fiber warming blanket (42°C), and Group 2, who received no warming of the abdomen. Neither group received any drug-based pain care. Patients were asked to rate their pain and anxiety by using visual analog scales (VAS). Statistical evaluation was performed with Student’s t-test; P < 0.05 was considered significant. In Group 1, a significant (P < 0.01) pain reduction was recorded in all cases on a visual analog scale (VAS), from 86.8 ± 5.5 mm to 41.2 ± 16.2 mm. In Group 2, the patients’ pain scores remained comparable, from 88.3 ± 9.9 mm to 88.1 ± 10.0 mm on a VAS. In comparing Group 1 with Group 2 on arrival at the hospital, pain scores showed a significant difference (P < 0.01). In Group 1, the VAS score changes for anxiety were significantly reduced (P < 0.01), from 82.7 ± 10.8 mm before treatment to 39.0 ± 14.0 mm after treatment. In Group 2, a nonsignificant change of this score was noted, from 84.5 ± 14.6 mm to 83.5 ± 8.4 mm. Comparing Group 1 with Group 2 on arrival at the hospital showed a significant difference in anxiety scores (P < 0.01). We conclude that local active warming is an effective and easy-to-learn treatment for pain resulting from acute cholelithiasis in emergency care.

IMPLICATIONS: Active local warming of the upper abdomen is an effective treatment for patients with cholelithiasis being transported to the hospital by paramedics who are not permitted to provide any drug-based pain care. We observed no negative side effects of this treatment.