Abstract
Background
Effective postoperative pain management after cesarean section is essential for maternal recovery and patient comfort. This prospective randomized controlled study aimed primarily to evaluate the effect of intermittent abdominal ice application on postoperative pain after elective cesarean section. Postoperative opioid consumption, patient satisfaction, and other recovery outcomes were evaluated as secondary outcomes.
Methods
This prospective randomized controlled study included 80 patients undergoing elective cesarean delivery under spinal anesthesia between May 2022 and October 2022. Patients were randomly allocated into two groups using a computer-generated randomization sequence in a 1:1 ratio: the ice group (n = 40) and the control group (n = 40). Allocation concealment was achieved using sequentially numbered opaque sealed envelopes prepared by an investigator who was not involved in patient recruitment or postoperative assessment. In the ice group, intermittent abdominal ice application was performed during the first 12 postoperative hours with a total application duration of 2 h. Postoperative pain intensity was evaluated using the Numeric Rating Scale (NRS) at postoperative 0, 2, 6, 12, and 24 h. Secondary outcomes included rescue tramadol and morphine use, time to first rescue analgesic administration, patient satisfaction, and length of hospital stay. Additional secondary analyses included the area under the postoperative NRS–time curve, responder analysis, and effect size assessment.
Results
Baseline demographic and perioperative characteristics were similar between the groups. Compared with the control group, the ice group demonstrated significantly lower median postoperative NRS scores at 2, 6, and 12 h (all p < 0.001), whereas no significant difference was observed at 24 h. Tramadol consumption [25.0 (0.0–25.0) mg vs. 50.0 (50.0–50.0) mg, p < 0.001] and morphine consumption [0.0 (0.0–0.0) mg vs. 0.0 (0.0–2.0) mg, p < 0.001] were significantly lower in the ice group. Patient satisfaction scores were significantly higher in the ice group [4.0 (3.0–4.0) vs. 3.0 (3.0–4.0), p < 0.001]. AUC analysis demonstrated a significantly lower postoperative pain burden in the ice group. Responder analysis demonstrated higher rates of acceptable postoperative pain control in patients receiving abdominal ice application.
Conclusion
Intermittent abdominal ice application was associated with lower early postoperative pain scores and higher patient satisfaction after elective cesarean section. Lower postoperative opioid consumption was also observed; however, this secondary finding should be interpreted cautiously because the initial rescue tramadol dose differed between the study groups. The intervention may serve as a simple adjunct to multimodal analgesia protocols after cesarean delivery.
Trial registration
ClinicalTrials.gov, NCT07626138. Registered on 29 May 2026. Retrospectively registered.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s12884-026-09687-w.
Keywords: Cesarean section, Local cold application, Postoperative pain, Multimodal analgesia, Opioid consumption, Abdominal ice application
Introduction
Effective postoperative analgesia after cesarean delivery is essential for maternal recovery, early mobilization, breastfeeding, maternal–newborn bonding, and patient satisfaction [1–4]. Current recommendations support regular paracetamol and nonsteroidal anti-inflammatory drugs as part of multimodal analgesia, with opioids reserved for rescue treatment when required [1, 5]. Concerns regarding opioid-related adverse effects have increased interest in simple nonpharmacological adjuncts that may improve postoperative pain control while limiting additional medication exposure [5, 6].
Local cold application may reduce pain through vasoconstriction, attenuation of tissue edema and inflammation, and slowing of peripheral nerve conduction [6]. The intervention evaluated in this study consisted specifically of intermittent ice-pack application over the abdominal incision and is therefore described as abdominal ice application rather than cryoanalgesia. Previous studies have reported variable analgesic effects of local cold application after surgery, including cesarean delivery, and the available evidence remains limited and heterogeneous with respect to application protocols and outcomes [7–9].
The primary objective of this randomized controlled study was to evaluate the effect of intermittent abdominal ice application during the first 12 postoperative hours on postoperative NRS pain scores during the first 24 h after elective cesarean section. The secondary objectives were to evaluate postoperative tramadol and morphine consumption, time to first rescue analgesic administration, total postoperative pain burden, responder status, patient satisfaction, and length of hospital stay.
The study was designed as a superiority trial. We hypothesized that intermittent abdominal ice application would result in lower postoperative NRS pain scores compared with standard postoperative care alone. The null hypothesis was that there would be no difference in postoperative NRS pain scores between the two groups.
Patients and methods
Study design and ethical approval
This prospective randomized controlled study was conducted at the Department of Obstetrics and Gynecology of Niğde Ömer Halisdemir University Training and Research Hospital between May 2022 and October 2022. Ethical approval was obtained from the Niğde Ömer Halisdemir University Non-Interventional Clinical Research Ethics Committee (approval number: 2022/33). Written informed consent was obtained from all participants before enrollment. The study was conducted in accordance with the principles of the Declaration of Helsinki. This randomized controlled trial was retrospectively registered on ClinicalTrials.gov (NCT07626138; registered on 29 May 2026). This study was designed, conducted, and reported in accordance with the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
Patient selection
Eighty pregnant women scheduled for elective cesarean delivery under spinal anesthesia were included in the study. Patients aged between 18 and 45 years with American Society of Anesthesiologists (ASA) physical status II were eligible for participation.
Exclusion criteria included refusal of spinal anesthesia, contraindications to neuraxial anesthesia, chronic opioid use, known allergy to study medications, severe systemic disease, psychiatric or neurological disorders affecting pain perception, infection at the application site, and inability to understand the Numeric Rating Scale (NRS).
Randomization and study groups
Patients were randomly allocated into two groups using a computer-generated randomization sequence in a 1:1 ratio: the ice group (n = 40) and the control group (n = 40). Allocation concealment was achieved using sequentially numbered opaque sealed envelopes prepared by an investigator who was not involved in patient recruitment or postoperative assessment. Postoperative outcome assessments were performed by an investigator who was blinded to group allocation. Patients in the control group received standard postoperative care, including the scheduled multimodal analgesia described below; no sham pack or other local intervention was applied.
Anesthesia protocol
Standard monitoring including electrocardiography, noninvasive blood pressure monitoring, and pulse oximetry was applied to all patients. Spinal anesthesia was performed at the L3–L4 or L4–L5 intervertebral space using a 25-gauge spinal needle with the patient in the sitting position. Hyperbaric bupivacaine (10–12 mg of 0.5%) was administered intrathecally according to institutional routine clinical practice. No intrathecal opioids were administered during spinal anesthesia.
Following surgery, all patients received scheduled postoperative multimodal analgesia consisting of intravenous paracetamol 1 g and intramuscular diclofenac sodium 75 mg, each administered twice at 12-hour intervals according to the institutional analgesia protocol.
Rescue analgesia was administered according to the institutional protocol used during the study. When the Numeric Rating Scale (NRS) pain score was ≥ 4 despite scheduled multimodal analgesia, patients in the ice group received intravenous tramadol 25 mg, whereas patients in the control group received intravenous tramadol 50 mg. Intravenous morphine 2 mg was administered for persistent clinically significant pain despite tramadol administration.
Ice application protocol
In the ice group, a commercially available reusable gel ice pack measuring 13 × 26 cm was placed inside a waterproof plastic bag and wrapped in a dry 100% cotton towel measuring approximately 30 × 40 cm, with a single towel layer positioned between the ice pack and the surgical dressing. The wrapped ice pack was placed over the intact and dry surgical dressing, centered on the incision, with its long axis positioned parallel to the incision. Direct skin contact and additional external compression were avoided. Gel ice packs of the same fixed size were used for all patients and were not adjusted according to incision length. Ice application was performed intermittently for 20 min every 2 h during the first 12 postoperative hours, corresponding to six sessions and a total application duration of 120 min. Before and after each session, the surgical dressing and surrounding skin were assessed for moisture, erythema, pallor, numbness, skin injury, and cold intolerance. The application was discontinued if dressing wetness, marked skin changes, or clinically significant cold intolerance occurred. Patients were also assessed for clinical signs of surgical-site infection before hospital discharge and at the routine postoperative follow-up visit.
Outcome measures
Primary outcome
The primary outcome was postoperative pain intensity during the first postoperative 24 h, evaluated using the Numeric Rating Scale (NRS; 0 = no pain, 10 = worst imaginable pain) at postoperative 0, 2, 6, 12, and 24 h.
Postoperative pain assessments were performed by an investigator who was blinded to group allocation.
Secondary outcomes
Secondary outcomes included tramadol consumption, morphine consumption, first analgesic request time, responder analysis, patient satisfaction scores, length of hospital stay, and total postoperative pain burden. Total postoperative pain burden was defined as the cumulative pain experience over time and quantified as the area under the postoperative NRS–time curve (AUC). Responder analyses included the proportions of patients achieving an NRS score ≤ 3 at each specified postoperative assessment time point and the proportion of patients who did not require postoperative morphine during the first 24 h. Patient satisfaction was evaluated at postoperative 24 h using a 5-point Likert scale, where 1 indicated very poor satisfaction and 5 indicated excellent satisfaction.
Sample size justification
Sample size estimation was performed using G*Power software (version 3.1) for the comparison of two independent groups. A previous randomized controlled study evaluating cold gel-pack application after cesarean delivery reported 6-hour postoperative VAS pain scores of 3.2 ± 2.4 in the intervention group and 5.3 ± 2.2 in the control group [7]. Based on these values, the estimated pooled standard deviation was approximately 2.30 and the standardized effect size was approximately 0.91. With a two-sided alpha level of 0.05, a beta error of 0.20, and 80% statistical power, the minimum required sample size was calculated as 20 patients per group. After allowing for an approximately 10% potential dropout rate, at least 22 patients per group were required. The final sample of 40 patients per group therefore exceeded the calculated minimum sample size.
Statistical analysis
Statistical analyses were performed using IBM SPSS Statistics software (version 25; IBM Corp., Armonk, NY, USA). Continuous variables were assessed for normality using the Shapiro–Wilk test. Normally distributed variables were analyzed using the independent samples t-test and presented as mean ± standard deviation, whereas non-normally distributed variables were analyzed using the Mann–Whitney U test and presented as median (interquartile range). Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. NRS scores and the 5-point patient satisfaction score were treated as ordinal variables. Postoperative tramadol and morphine consumption had discrete, non-normal distributions because these medications were administered in fixed-dose increments. Therefore, NRS scores, patient satisfaction scores, and postoperative opioid consumption were presented as median (interquartile range) and compared between groups using the Mann–Whitney U test. Tramadol and morphine consumption were analyzed and reported separately and were not combined into a single opioid-equivalent outcome.
Effect size analysis for nonparametric comparisons was performed using rank-biserial correlation coefficients (r). Total postoperative pain burden was evaluated using area under the curve (AUC) analysis calculated from serial postoperative NRS measurements using the trapezoidal method. Statistical significance was defined as a two-sided p value < 0.05. Because postoperative pain scores were assessed at predefined clinically relevant postoperative time points, separate between-group comparisons were performed for each assessment time point.
Results
A total of 80 patients were included in the final analysis. A CONSORT flow diagram of patient enrollment, randomization, follow-up, and analysis is presented in Fig. 1. Baseline demographic and perioperative characteristics were comparable between the groups. No significant differences were observed regarding age, body mass index, operation duration, or surgical duration (Table 1).
Fig. 1.
CONSORT flow diagram of patient enrollment, randomization, follow-up, and analysis in the ice and control groups
Table 1.
Baseline characteristics
| Variable | Ice Group (n = 40) | Control Group (n = 40) | p value |
|---|---|---|---|
| Age (years) | 30.03 ± 6.62 | 31.40 ± 5.99 | 0.333 |
| BMI (kg/m²) | 27.92 ± 4.81 | 28.24 ± 4.72 | 0.763 |
| Operation duration (min) | 48.35 ± 7.71 | 46.30 ± 7.67 | 0.237 |
| Surgical duration (min) | 40.55 ± 7.97 | 38.83 ± 7.57 | 0.324 |
Values are presented as mean ± standard deviation
BMI body mass index
Postoperative pain scores are summarized in Table 2 and illustrated in Fig. 2. Baseline postoperative NRS scores at 0 h were similar between the groups [4.0 (3.0–5.0) vs. 4.0 (3.75–5.0), p = 0.520]. However, the ice group demonstrated significantly lower postoperative NRS scores at 2 h [3.0 (2.0–4.0) vs. 5.0 (4.75–6.0), p < 0.001], 6 h [2.0 (1.0–3.0) vs. 5.0 (4.75–6.0), p < 0.001], and 12 h [3.0 (2.0–4.0) vs. 4.0 (3.75–5.0), p < 0.001]. No significant difference was observed at postoperative 24 h [3.0 (2.0–4.0) vs. 3.0 (2.75–4.0), p = 0.520] (Table 2; Fig. 2).
Table 2.
Postoperative pain scores
| Variable | Ice Group (n = 40) | Control Group (n = 40) | p value |
|---|---|---|---|
| NRS at postoperative 0 h | 4.0 (3.0–5.0) | 4.0 (3.75–5.0) | 0.520 |
| NRS at postoperative 2 h | 3.0 (2.0–4.0) | 5.0 (4.75–6.0) | < 0.001 |
| NRS at postoperative 6 h | 2.0 (1.0–3.0) | 5.0 (4.75–6.0) | < 0.001 |
| NRS at postoperative 12 h | 3.0 (2.0–4.0) | 4.0 (3.75–5.0) | < 0.001 |
| NRS at postoperative 24 h | 3.0 (2.0–4.0) | 3.0 (2.75–4.0) | 0.520 |
Values are presented as median (interquartile range). Between-group comparisons were performed using the Mann–Whitney U test
NRS numeric rating scale
Fig. 2.
Postoperative Numeric Rating Scale (NRS) pain scores at different postoperative time points in the ice and control groups. Data are presented as median and interquartile range (IQR)
Analgesic consumption and secondary outcomes are presented in Table 3. Tramadol consumption was significantly lower in the ice group compared with the control group [25.0 (0.0–25.0) mg vs. 50.0 (50.0–50.0) mg, p < 0.001]. Similarly, postoperative morphine consumption was significantly lower in the ice group [0.0 (0.0–0.0) mg vs. 0.0 (0.0–2.0) mg, p < 0.001]. Patient satisfaction scores were significantly higher in the ice group [4.0 (3.0–4.0) vs. 3.0 (3.0–4.0), p < 0.001]. No significant differences were detected regarding first analgesic request time or length of hospital stay (Table 3). No dressing wetness, skin injury, frost injury, or cold intolerance was observed during the ice-application period. No clinical signs of surgical-site infection were detected before hospital discharge or at the routine postoperative follow-up visit.
Table 3.
Analgesic consumption and secondary outcomes
| Variable | Ice Group (n = 40) | Control Group (n = 40) | p value |
|---|---|---|---|
| Tramadol consumption (mg) | 25.0 (0.0–25.0) | 50.0 (50.0–50.0) | < 0.001 |
| Morphine consumption (mg) | 0.0 (0.0–0.0) | 0.0 (0.0–2.0) | < 0.001 |
| First analgesic request time (min) | 75.5 (50.0–104.0) | 69.5 (51.25–98.25) | 0.623 |
| Length of hospital stay (h) | 43.0 (41.0–45.25) | 44.0 (40.0–47.0) | 0.735 |
| Patient satisfaction score | 4.0 (3.0–4.0) | 3.0 (3.0–4.0) | < 0.001 |
Values are presented as median (interquartile range). Between-group comparisons were performed using the Mann–Whitney U test. Postoperative opioid consumption was evaluated using tramadol and morphine requirements
The area under the postoperative NRS–time curve was significantly lower in the ice group for both the 0–12-hour and 0–24-hour periods, indicating a lower cumulative postoperative pain burden (Table 4; Fig. 3).
Table 4.
Area under the curve (AUC) analysis of postoperative pain burden
| Outcome | Ice Group (n = 40) | Control Group (n = 40) | p value |
|---|---|---|---|
| AUC 0–12 h | 32.0 (20.0–44.0) | 56.0 (53.0–68.0) | < 0.001 |
| AUC 0–24 h | 68.0 (44.0–92.0) | 98.0 (92.0–122.0) | < 0.001 |
Values are presented as median (interquartile range)
AUC area under the curve
AUC values are expressed as NRS·h
Fig. 3.
Area under the postoperative Numeric Rating Scale (NRS)–time curve for the 0–12-hour and 0–24-hour postoperative periods in the ice and control groups. Boxes represent the interquartile range, horizontal lines indicate the median, and individual points represent patient-level values. Between-group comparisons were performed using the Mann–Whitney U test
Effect size analysis demonstrated large effects favoring the ice group for NRS scores at postoperative 2, 6, and 12 h and for tramadol consumption, with moderate effects for morphine consumption and patient satisfaction (Table 5).
Table 5.
Effect size analysis for postoperative outcomes
| Outcome | Rank-biserial correlation (r) | Interpretation |
|---|---|---|
| NRS at postoperative 0 h | 0.079 | Negligible |
| NRS at postoperative 2 h | 0.900 | Large |
| NRS at postoperative 6 h | 1.000 | Large |
| NRS at postoperative 12 h | 0.611 | Large |
| NRS at postoperative 24 h | 0.079 | Negligible |
| Tramadol consumption | 1.000 | Large |
| Morphine consumption | 0.475 | Moderate |
| Patient satisfaction score | 0.438 | Moderate |
NRS numeric rating scale
Responder analysis revealed significantly higher responder rates in the ice group. The proportion of patients achieving NRS ≤ 3 at postoperative 2, 6, and 12 h was significantly greater in the ice group compared with the control group. In addition, all patients in the ice group remained free of postoperative morphine requirement, whereas only 52.5% of patients in the control group required no postoperative morphine (Table 6).
Table 6.
Responder analysis
| Outcome | Ice Group (n = 40) | Control Group (n = 40) | p value |
|---|---|---|---|
| NRS ≤ 3 at postoperative 2 h | 24/40 (60.0%) | 0/40 (0%) | < 0.001 |
| NRS ≤ 3 at postoperative 6 h | 40/40 (100%) | 0/40 (0%) | < 0.001 |
| NRS ≤ 3 at postoperative 12 h | 24/40 (60.0%) | 10/40 (25.0%) | 0.003 |
| No postoperative morphine requirement | 40/40 (100%) | 21/40 (52.5%) | < 0.001 |
Values are presented as number (percentage). Responder analyses separately evaluated the proportions of patients with NRS ≤ 3 at each postoperative assessment time point and the proportion of patients without postoperative morphine requirement during the first 24 h
The absolute difference in the proportion of patients requiring postoperative morphine was 47.5%, corresponding to an exploratory number needed to treat of 2.11.
Discussion
The present randomized controlled study demonstrated that intermittent abdominal ice application during the first 12 postoperative hours after elective cesarean section was associated with lower early postoperative pain scores, lower observed postoperative opioid consumption, lower total postoperative pain burden, and higher patient satisfaction compared with standard postoperative care alone. The analgesic benefit was most evident at postoperative 2, 6, and 12 h, whereas pain scores were comparable between groups at 24 h. This pattern suggests that abdominal ice application may provide its main benefit during the early inflammatory and nociceptive phase after surgery.
Effective postoperative pain management after cesarean delivery is essential for maternal recovery and overall postpartum well-being. Inadequate pain control may impair early mobilization, breastfeeding, maternal–infant bonding, and patient satisfaction [1, 2]. In addition, severe acute postoperative pain after childbirth has been associated with an increased risk of persistent postpartum pain and postpartum depression [4]. Postoperative pain remains undertreated in a substantial proportion of surgical patients despite advances in perioperative analgesia protocols [10]. For this reason, contemporary obstetric anesthesia guidelines emphasize the importance of effective multimodal analgesia strategies following cesarean Sects [1, 5].
In recent years, opioid-sparing approaches have gained increasing importance in postoperative obstetric analgesia because opioid-related adverse effects may negatively influence maternal recovery and patient comfort. Nausea, vomiting, sedation, dizziness, delayed mobilization, and concerns regarding neonatal exposure through breastfeeding have encouraged the development of adjunctive nonpharmacological analgesic strategies [3, 5]. Current procedure-specific recommendations for cesarean delivery therefore support multimodal analgesia protocols that minimize opioid consumption whenever possible [1]. Postoperative tramadol and morphine use differed between the groups. However, because the initial rescue tramadol dose was not identical between the study groups, these findings may have been influenced by the analgesic protocol itself and should therefore be interpreted cautiously.
The analgesic effects of local cold application are believed to result from several physiological mechanisms, including local vasoconstriction, reduction of tissue edema, suppression of inflammatory mediator release, and slowing of peripheral nerve conduction velocity [6, 11]. Through these mechanisms, cold application may reduce nociceptive transmission originating from the surgical incision site and attenuate the local inflammatory response during the early postoperative period. The findings of the present study are consistent with this physiological rationale, as the most pronounced analgesic benefit was observed during the first postoperative hours, whereas the difference between groups diminished by postoperative 24 h.
Previous studies evaluating postoperative cold application after cesarean delivery have reported heterogeneous findings. Earlier studies reported limited objective analgesic benefit associated with localized cold therapy after cesarean delivery [8]. In contrast, more recent randomized studies demonstrated that postoperative cold gel pack application significantly reduced postoperative pain scores and analgesic consumption following cesarean Sect [7]. Similarly, systematic evaluations of local cold application in surgical patients suggested that cold application may contribute to postoperative pain reduction and opioid-sparing effects, although the magnitude of benefit appears to vary according to the surgical procedure and cold-application protocol used [6].
One of the notable strengths of the present study is the inclusion of several clinically oriented analytical approaches beyond conventional postoperative pain score comparisons. In addition to serial NRS assessments, we evaluated total postoperative pain burden using area under the curve (AUC) analysis, responder analysis, and effect size analysis. These complementary analyses suggested that abdominal ice application was associated with reductions in postoperative pain scores and lower observed opioid requirements during the early postoperative period. Furthermore, responder analysis demonstrated substantially higher rates of clinically acceptable pain control in the ice group. The observed difference in postoperative morphine requirement corresponded to an exploratory number needed to treat of 2.11.
From a clinical perspective, abdominal ice application may represent a simple adjunctive analgesic intervention because it is inexpensive, easy to apply, noninvasive, and does not require additional pharmacological exposure. Contemporary enhanced recovery and multimodal postoperative analgesia pathways increasingly emphasize opioid-sparing strategies and nonpharmacological supportive interventions to improve postoperative recovery and patient comfort [12–16]. Unlike systemic analgesics, local cold application is not associated with opioid-related adverse effects and may be incorporated into standard postoperative nursing care protocols [17, 18]. Therefore, abdominal ice application may be particularly valuable in enhanced recovery and multimodal analgesia pathways aimed at improving postoperative recovery after cesarean delivery.
Strengths and limitations
The present study has several strengths. First, the randomized controlled design and the standardized spinal anesthesia and scheduled non-opioid analgesia protocols increased the internal consistency of the study. Second, postoperative pain was evaluated serially at multiple clinically relevant time points during the first 24 postoperative hours. Third, both subjective pain scores and objective opioid consumption parameters were assessed. Finally, the incorporation of additional analytical approaches such as AUC analysis, responder analysis, and effect size assessment allowed a broader evaluation of the clinical relevance of abdominal ice application after cesarean delivery.
The present study also has several limitations. First, the study was conducted at a single center with a relatively limited sample size, which may restrict the generalizability of the findings. Second, although postoperative pain assessments were performed by a blinded investigator, blinding of the intervention itself was not feasible because patients were aware of cold application, which may have influenced subjective pain reporting. Because no sham pack was used in the control group, the specific effect of cold could not be fully distinguished from the nonspecific effects of pack placement and contact pressure, although no additional external compression was applied. Third, postoperative pain perception is inherently subjective and may be influenced by individual psychological, emotional, and sociocultural factors. In addition, long-term postoperative outcomes such as persistent pain, breastfeeding quality, functional recovery, and maternal quality of life were not evaluated. Fourth, the initial rescue tramadol dose differed between the study groups, and morphine was used for persistent pain. Consequently, postoperative opioid-consumption findings may have been influenced by the rescue analgesia protocol and should be interpreted cautiously. Future studies should use identical rescue analgesic dosing across study groups to more accurately assess the effect of abdominal ice application on postoperative opioid requirements. Finally, although the study demonstrated significant early postoperative analgesic benefits, further multicenter studies with larger patient populations are needed to confirm these findings and optimize abdominal ice-application protocols after cesarean delivery.
Conclusion
In conclusion, intermittent abdominal ice application after elective cesarean section significantly reduced early postoperative pain scores and improved patient satisfaction. Lower postoperative opioid consumption was also observed; however, this finding should be interpreted cautiously because the initial rescue tramadol dose differed between the study groups. Intermittent abdominal ice application may serve as a simple adjunct to multimodal analgesia protocols after cesarean delivery. Further multicenter studies are warranted to confirm these findings and optimize abdominal ice-application protocols in obstetric patients.
Supplementary Information
Supplementary Material 3. Anonymized study dataset.
Acknowledgements
The authors would like to thank all participants who contributed to this study.
Authors’ contributions
Seval Kılbasanlı contributed to the conception and design of the study, patient follow-up, data collection, statistical analysis, interpretation of the results, and manuscript drafting and revision. Osman Aydın contributed to patient recruitment, obstetric management, and data acquisition. Bülent Çakmak contributed to study supervision, interpretation of the findings, and critical revision of the manuscript. All authors read and approved the final manuscript.
Funding
This research received no external funding.
Data availability
All relevant data are included within the manuscript and its Supporting Information files.
Declarations
Ethics approval and consent to participate
The study protocol received approval from the Niğde Ömer Halisdemir University Non-Interventional Clinical Research Ethics Committee (approval number: 2022/33). Written informed consent was obtained from all participants prior to enrollment, and the study was conducted in accordance with the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Material 3. Anonymized study dataset.
Data Availability Statement
All relevant data are included within the manuscript and its Supporting Information files.