By: Amal N Abboud, Naglaa M. El Mokadem, and Shaimaa E. Abdullah
1Lecturer, Critical Care and Emergency Nursing Department, Faculty of Nursing, Menoufia University, Menoufia, Egypt
2 Professor, Critical Care and Emergency Nursing Department, Faculty of Nursing, Menoufia University, Menoufia, Egypt
3 Assistant Professor, Critical Care and Emergency Nursing Department, Faculty of Nursing, Menoufia University, Menoufia, Egypt
Background: Craniotomy is a fundamental approach for managing traumatic brain injuries globally. Patients recovering from craniotomy often experience moderate to severe pain, along with periorbital swelling and bruising. Cold therapy and Aloe Vera Gel are non-pharmacological methods that may help alleviate pain and reduce edema after the procedure. The aim of this study is to compare the effectiveness of cold therapy versus Aloe Vera Gel in decreasing pain, periorbital swelling, and bruising following craniotomy. The study involved a convenient sample of 90 patients admitted to the neurosurgery ICU, employing a quasi-experimental design with both study and control groups. Setting: Neuro surgery ICU at Menoufia University Hospital, Shebin EL-Kom, Egypt. Instruments: 1) Demographic and Medical data sheet; 2) Visual Analog Scale for Pain (VAS) used to measure pain intensity post cranitomy; 3) Modified Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) used to assess periorbital edema and ecchymosis post craniotomy ; 4) Glasgow Coma Scale used as screening tool to assess conscious level. Results: There was a statistically significant difference between study groups who received cold application compared to the group who received Aloe Vera Gel regarding for pain intensity post intervention (p < 0.001). Periorbital edema and ecchymosis was significantly reduced in the study group who received cold application compared to the group who received Aloe Vera Gel (p < 0.001). Conclusion: Cold Application is superior to Aloe Vera gel in reducing pain intensity, periorbital edema and ecchymosis post craniotomy. Recommendation: Encourage critical care nurses to create practice guidelines for managing pain after craniotomy, incorporating cold therapy as a non-pharmacological option.
Key Words: Aloe Vera Gel, Cold Application, Ecchymosis, Periorbital Edema, Post Craniotomy.
Citation:
Refrences:
1- Y. Derina, Mrs. Sasikala, T. Nirmala. A True Experimental study to Evaluate the effect of Ice Gel Pack Application on Peri Orbital Edema among patients after Craniotomy Surgery. Asian Journal of Nursing Education and Research. 2022; 12(3):335-8. doi: 10.52711/2349-2996.2022.00069 Available on: https://ajner.com/AbstractView.aspx?PID=2022-12-3-15.
2- Chughtai KA, Nemer OP, Kessler AT, Bhatt AA. Post-operative complications of craniotomy and craniectomy. Emerg Radiol. 2019 Feb;26(1):99-107. doi: 10.1007/s10140-018-1647-2. Epub 2018 Sep 25. PMID: 30255407.
3- Panigrahi, Arun Kumar; Senapati, Satya Bhusan; Panda, Debasish; Panigrahi, Subhasish. A rare case of periorbital edema and conjunctival prolapse due to traumatic intraorbital CSF leakage. Journal of Pediatric Neurosciences 17(4):p 335-337, October-December 2022. | DOI: 10.4103/jpn.JPN_328_20.
4- Teo JH, Palmer GM, Davidson AJ. Post-craniotomy pain in a paediatric population. Anaesth Intensive Care. 2011 Jan;39(1):89-94. doi: 10.1177/0310057X1103900115. PMID: 21375097.
5- Santos CMT, Pereira CU, Chaves PHS, Tôrres PTRL, Oliveira DMDP, Rabelo NN. Options to manage postcraniotomy acute pain in neurosurgery: no protocol available. Br J Neurosurg. 2021 Feb;35(1):84-91. doi: 10.1080/02688697.2020.1817852. Epub 2020 Sep 23. PMID: 32966104.
6- Sanober A, Rashid M, Khan MI, Rehman SU, Yousaf S, Rehman Orakzai IU, Fatima S, Eitezaz FA, Hussain A. Use Of Steroids In Rhinoplasty With Lateral Osteotomies For Reducing Post Operative Oedema. J Ayub Med Coll Abbottabad. 2018 Jan-Mar;30(1):45-48. PMID: 29504328.
7- Koc EK, Besir A, Tugcugil E, Livaoğlu M. The effects of 5-degree, 10-degree and 20-degree reverse Trendelenburg positions on intraoperative bleeding and postoperative Edemea and ecchymosis around the eye in open rhinoplasty. Am J Otolaryngol. 2022 Mar-Apr;43(2):103311. doi: 10.1016/j.amjoto.2021.103311. Epub 2021 Dec 3. PMID: 34894451.
8- Handayani, S., Aprilia, D., Nisa, K., Rosyida, V. T., Wulanjati, M. P., Windarsih, A., & Haryanti, S. (2021). A Mini-Review: Possible Mechanisms of Hepatoprotective Effect of Aloe Vera Gel. Indonesian Journal of Cancer Chemoprevention,202:12(3), 170-179.
9- Essa, R., Mohamed, N., & Kandeel, H. (2020). Effect of aloe vera gel versus normal saline on pain relief and healing process of episiotomy. Journal of Health, Medicine and Nursing,2020:70, 66-81.
10- Dunbar PJ, Visco E, Lam AM. Craniotomy procedures are associated with less analgesic requirements than other surgical procedures. Anesth Analg. 1999 Feb;88(2):335-40. doi: 10.1097/00000539-199902000-00021. PMID: 9972752.
11- Zeng, W. , Parus, A. , Barnes, C. , Hiro, M. , Robson, M. and Payne, W. (2020) Aloe vera—Mechanisms of Action, Uses, and Potential Uses in Plastic Surgery and Wound Healing. Surgical Science, 11, 312-328. doi: 10.4236/ss.2020.1110033.
12- Hekmatpou D, Mehrabi F, Rahzani K, Aminiyan A. The Effect of Aloe Vera Clinical Trials on Prevention and Healing of Skin Wound: A Systematic Review. Iran J Med Sci. 2019 Jan;44(1):1-9. PMID: 30666070; PMCID: PMC6330525.
13- Rychen J, Croci D, Roethlisberger M, Nossek E, Potts M, Radovanovic I, Riina H, Mariani L, Guzman R, Zumofen DW. Minimally Invasive Alternative Approaches to Pterional Craniotomy: A Systematic Review of the Literature. World Neurosurg. 2018 May;113:163-179. doi: 10.1016/j.wneu.2018.02.016. Epub 2018 Feb 13. PMID: 29452317.
14- Motamedi Mohamad-Abadi N, Haghighat S, Tajmir-Riahi M, Asgary S, Eghbali-Babadi M. The Effect of Aloe Vera Gel on Saphenous Vein Harvest Wound Healing and Local Pain in Non-diabetic Patients Undergoing CABG Surgery: A Clinical Trial. Shiraz E-Med J. 2023;24(1):e122766. https://doi.org/10.5812/semj-122766.
15- Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020 Sep 1;161(9):1976-1982. doi: 10.1097/j.pain.0000000000001939. PMID: 32694387; PMCID: PMC7680716.
16- Cline ME, Herman J, Shaw ER, Morton RD. Standardization of the visual analogue scale. Nurs Res. 1992 Nov-Dec;41(6):378-80. PMID: 1437591.
17- Alghadir AH, Anwer S, Iqbal A, Iqbal ZA. Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018 Apr 26;11:851-856. doi: 10.2147/JPR.S158847. PMID: 29731662; PMCID: PMC5927184.
18- Kara CO, Gökalan I. Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plast Reconstr Surg. 1999 Dec;104(7):2213-8. doi: 10.1097/00006534-199912000-00041. PMID: 11149790.
19- Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81-4. doi: 10.1016/s0140-6736(74)91639-0. PMID: 4136544.
20- Park S, Davis AE. Effectiveness of direct and non-direct auditory stimulation on coma arousal after traumatic brain injury. Int J Nurs Pract. 2016 Aug;22(4):391-6. doi: 10.1111/ijn.12448. Epub 2016 May 30. PMID: 27241789. Park S, Davis AE. Effectiveness of direct and non-direct auditory stimulation on coma arousal after traumatic brain injury. Int J Nurs Pract. 2016 Aug;22(4):391-6. doi: 10.1111/ijn.12448. Epub 2016 May 30. PMID: 27241789.
21- Katz DI, Alexander MP. Traumatic brain injury. Predicting course of recovery and outcome for patients admitted to rehabilitation. Arch Neurol. 1994 Jul;51(7):661-70. doi: 10.1001/archneur.1994.00540190041013. PMID: 8018038.
22- Hansen MS, Brennum J, Moltke FB, Dahl JB. Pain treatment after craniotomy: where is the (procedure-specific) evidence? A qualitative systematic review. Eur J Anaesthesiol. 2011 Dec;28(12):821-9. doi: 10.1097/EJA.0b013e32834a0255. PMID: 21971206.
23- Bui MH, Dong HV, Duong HD, VAN HD, Dong SV, Bui CX, Chu HT. Malignant cerebral edema after cranioplasty, a rare complication: case series and literature review. Ann Med Surg (Lond). 2023 May 17;85(6):3187-3195. doi: 10.1097/MS9.0000000000000856. PMID: 37363521; PMCID: PMC10289794.
24- Agha RA, Sohrabi C, Mathew G, Franchi T, Kerwan A, O’Neill N; PROCESS Group. The PROCESS 2020 Guideline: Updating Consensus Preferred Reporting Of CasESeries in Surgery (PROCESS) Guidelines. Int J Surg. 2020 Dec;84:231-235. doi: 10.1016/j.ijsu.2020.11.005. Epub 2020 Nov 12. PMID: 33189880.
25- Yüksel, S., & Akyolcu, N. (2020). Effect of Cold Application and Heparinoid on Periorbital Edema and Ecchymosis after Craniotomy: A Randomized Controlled Clinical Trial. International Journal of Academic Medicine and Pharmacy.1:15:15-25pp.
26- Fernandes IA, Armond ACV, Falci SGM. The Effectiveness of the Cold Therapy (cryotherapy) in the Management of Inflammatory Parameters after Removal of Mandibular Third Molars: A Meta-Analysis. Int Arch Otorhinolaryngol. 2019 Apr;23(2):221-228. doi: 10.1055/s-0039-1677755. Epub 2019 Mar 13. PMID: 30956709; PMCID: PMC6449133.
27- Kaviani H, Abdiyazdan GH, Ghodousi A, Paryavi B. (2015).The impact of cryotherapy on reducing postoperative periorbital ecchymosis 25 and nasal edema in patients undergoing rhinoplasty. Bulletin of Environment, Pharmacology and Life Sciences.; 2015:4(6):22–29.
28- Wang S, Luan Y, Peng T, Wang G, Zhou L, Wu W. Malignant cerebral edema after cranioplasty: a case report and literature review. Brain Inj. 2023 Jan 9:1-7. doi: 10.1080/02699052.2023.2165157. Epub ahead of print. PMID: 36625002.
29- Kim S., Choi,J., YimT., Lee H. A Case Study of Eyelid Edema Post Craniotomy. The Journal of Internal Korean Medicine,2021:42(5), 939-948.
30- Kayiran O, Calli C. The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study. Rhinology. 2016 Mar;54(1):32-7. doi: 10.4193/Rhino15.177. PMID: 26713321.