Do I need to use a towel between the pad and my skin

If straight out of frezzer yes. Leave for 5 mins then no need.

Does anyone know the size as it doesnt state it ?

The whole circumference which includes the fixing strap is 110 cm ( which is 43-44 inches) the size of the “pad” which goes over/around knee is approx 25 x 25 cm, it fixes easily, it has really helped and I have mostly put in fridge chiller drawer as opposed to freezer, it’s been great

Can it be worn during the night?

its not recomended to wear during the night only wear for 20 mins while frozenand cold always with a cloth underneath worked wonders for my partner after knee op .

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❄️ Wrap, Chill, Heal — Your Knee’s New Best Friend

DUAL SIDED COMFORT - Silky nylon for deep therapy, fuzzy side prevents cold burns for gentle icing
EXTENDED COLD RETENTION - 30% extra gel with -13℉ freezing point keeps cold longer and molds perfectly
HANDS FREE UNIVERSAL FIT - 3 adjustable straps ensure non-slip comfort for left or right knee, men or women
CONVENIENT STORAGE SUPPORT - Includes sealable bag to keep gel fresh and odor-free, backed by responsive customer care
FULL KNEE COVERAGE INSTANT RELIEF - Wraps around entire knee for all-around pain and swelling control

The NEWGO Ice Pack for Knee Replacement Surgery is a reusable gel wrap designed to provide full knee coverage with 30% more gel for longer-lasting cold therapy at -13℉. Featuring 3 adjustable straps for a secure, hands-free fit on either knee, it offers dual hot and cold therapy with a double-sided design for effective pain relief and swelling reduction. Comes with a sealable storage bag to maintain freshness and backed by responsive customer support.