Background <p>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.</p> Methods <p>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 (<i>n</i> = 40) and the control group (<i>n</i> = 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&#xa0;h. Postoperative pain intensity was evaluated using the Numeric Rating Scale (NRS) at postoperative 0, 2, 6, 12, and 24&#xa0;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.</p> Results <p>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&#xa0;h (all <i>p</i> &lt; 0.001), whereas no significant difference was observed at 24&#xa0;h. Tramadol consumption [25.0 (0.0–25.0) mg vs. 50.0 (50.0–50.0) mg, <i>p</i> &lt; 0.001] and morphine consumption [0.0 (0.0–0.0) mg vs. 0.0 (0.0–2.0) mg, <i>p</i> &lt; 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), <i>p</i> &lt; 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.</p> Conclusion <p>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.</p> Trial registration <p>ClinicalTrials.gov, NCT07626138. Registered on 29 May 2026. Retrospectively registered.</p>