Where the ERAS protocol stops:
the week after discharge

An effect measured on top of full analgesia

In the reference study, the control group was already receiving intrathecal morphine and a ropivacaine infiltration under an ERAS protocol, and cryocompression still halved morphine consumption.

That is the central point, and what sets this data apart from the rest: the effect was not measured against the absence of a protocol, it was measured on top of a properly conducted multimodal analgesia protocol.

The Reims study

Sixty patients operated on for a lumbar fusion at L4L5, L5S1 or L4S1, split into two consecutive sets of thirty, under the same anaesthetic protocol¹. The second group wore the Game Ready® belt from the moment of awakening, continuously at 4 °C for 48 hours.

At the sixth hour there is no difference, the intrathecal morphine still masking the effect. The gap appears from H24, and it holds.

Morphine consumption was halved at 24 and at 48 hours (p = 0.01 and p < 0.0001), and pain itself was significantly lower at both of those timepoints¹.

Those last two results are the ones an ERAS protocol cares about most. One and a fifth days less in hospital (p < 0.001), and blood loss close to halved (p = 0.0003), consistent with cold induced vasoconstriction.

The same signal in knee arthroplasty

A British prospective study followed 384 consecutive patients after total knee arthroplasty, 191 without cryotherapy then 193 with, operated on by the same surgeons and followed by the same team².

Median Oramorph consumption over the first three days was 15 mg against 40 (p < 0.01), pain was lower on each of the three days, and length of stay was shorter, 3.86 against 4.20 days (p = 0.02)².

Neither study is a randomised trial. These are consecutive series compared with one another, with the level of evidence that implies. They do however cover 444 patients in total, across two very different procedures, and they point the same way on the same three criteria: pain, opioids, length of stay.

Where the protocol stops

Reducing opioids is an explicit pillar of ERAS recommendations in orthopaedics³. Nausea, constipation, confusion and drowsiness are all mechanical obstacles to early mobilisation, which is itself a discharge criterion.

ERAS in spine surgery is now well established. A systematic review of 81 studies concludes that it reduces complications and length of stay⁴.

But the more these protocols shorten the stay, the greater the share of recovery that happens at home. The patient leaves at day 1 or day 3 with pain controlled in hospital, and loses on the way out the device that was helping to control it. That is precisely the discontinuity home rental fills.

The protocol in practice

In hospital, the Reims study used a continuous application through the first 48 hours, starting on leaving theatre.

At home, the first week runs on regular sessions spread through the day, independently of physiotherapy: on waking, in the afternoon, and one in the evening before bed, often the one that changes the night the most. This is the period when oedema and pain are at their peak and when the rhythm matters more than the timing.

Only after that do sessions come to frame physiotherapy: before, to mobilise a joint that hurts less, and after, to contain the inflammatory response to the effort. And occasionally beyond that, after a longer day or an unusual effort, when the swelling comes back up in the evening.

Kolde at the patient's home

Kolde rents the Game Ready® GRPro 2.1 directly to the patient's home, with delivery, set-up and a hands-on walkthrough by a member of the team, and support reachable at any hour. The hospital protocol in Reims stopped at the 48th hour¹. Discharge happens between day 1 and day 3. The rental covers the interval between the two.