A Cochrane review included 10 trials comparing local cooling treatments (ice packs, cold gel pads (with or without compression), or cold/iced baths) with no treatment, gel pads with compression, hamamelis water (witch hazel), pulsed electromagnetic energy (PET), hydrocortisone/pramoxine foam, oral paracetamol, or warm baths. 1 825 women were involved. Ice packs provided improved pain relief 24 to 72 hours after birth compared with no treatment (RR 0.61, 95% CI 0.41 to 0.91, 1 trial, n=208). Women preferred the utility of the gel pads compared with ice packs or no treatment (RR 0.82, 95% CI 0.73 to 0.92). Differences detected in a composite of perineal oedema and bruising and overall wound healing were noted in one small study, favouring cold gel pads (n=37) over ice (n=35, MD 0.63 on a scale of 0 to 15, 95% CI 0.20 to 1.06) or no treatment (n=39, MD -2.10, 95% CI -3.80 to -0.40) three to 14 days after giving birth. Women reported more pain (RR 5.60, 95% CI 2.35 to 13.33; 1 study, n=100) and used more additional analgesia (RR 4.00, 95% CI 1.44 to 11.13; 1 study, n=100) following the application of ice packs compared with PET.
Comment: The quality of evidence is downgraded by study limitations (lack of blinding), by inconsistency (variability in results across studies), and by imprecise results (limited study size for each comparison).