Pain Management
Will my child be in pain after surgery?
After surgery, there may be physical causes of pain, but the sensation of pain also depends on complex mental and emotional factors. Determining the level of pain a child is experiencing can be very challenging, especially if the child is very young or has delayed verbal skills. The surgical team may use a scale of 0 to 10 or illustrations of faces to help children describe pain. Our doctors and nurses can typically determine what is usual discomfort for a certain procedure and give the prescribed medication; however, we know that each child’s best expert is his or her family. If the patient is unusually agitated or withdrawn, caregivers should let us know so we can assess the effectiveness of the prescribed medication.
What pain medications will my child receive?
There are a wide variety of pain medications that a child can receive after surgery. The patient’s physician will order the specific medication(s) he or she thinks will be most effective based on the type of surgery, the child’s age and development and any previous experience the child has had with surgery and pain medications.If the child has moderate to severe pain, he or she will most likely receive opioid pain medication during and after surgery. There is minimal risk of addiction when opioids are used short-term for pain control. If the child is in the intensive care unit after surgery, he or she may also receive sedatives along with pain medications. Sedatives can decrease anxiety, induce sleep and eliminate the memory of unpleasant events.
How will my child receive pain medication?
If your child is receiving non-opioid pain medication, they are often given in pill form for older children and as a liquid medication for younger children. Sometimes, a child may experience nausea and vomiting after surgery; in this instance, suppositories can be used if needed. Some patients may receive an intravenous (IV) line before surgery. Many pain medications can be given in the intravenous (IV) fluids that are infused into the child’s vein.
What is an epidural pump?
During certain surgeries, epidural anesthesia is used. This type of anesthesia is given through a small catheter into the “epidural space” surrounding the spinal cord. The catheter can be connected to a pump that will give a constant flow of medication. After surgery, this catheter can be left in for one or two days.
What is a PCA pump?
PCA stands for “patient-controlled analgesia.” With a PCA pump, the child can receive a continuous dosage of pain medication through an IV, an intermittent dosage or both. With intermittent dosages, the child decides when he or she feels bad and pushes a button that administers a dose of pain medication. For example, the patient may come back from surgery with a PCA pump that has been programmed to give pain medication at a continuous dosage every hour. The pump can also be programmed for the child to give additional amounts of medication as needed, by pushing a button. The dosage is determined by the child’s physician, and the child cannot give themself too much. The day after surgery, the child’s surgeon may discontinue the continuous infusion, and then only intermittent dosages will be given when the button is pushed. The pump settings can only be adjusted by the child’s healthcare team with a special key. Children as young as 4 years old have been shown to use PCA pumps effectively.
Will my child receive pain medications at home?
The child’s physician will discuss the need for medications at home before and after surgery. If necessary, caregivers will be given prescriptions for pain medication before being discharged to go home. In many cases, patients can take over-the-counter pain medications. The patient’s doctor will discuss these medications and their dosages.
How can I relieve my child’s discomfort?
Parents can comfort their child better than anyone else. The following are some suggestions that might prove helpful in comforting children in pain:
- All children need to be held, stroked and touched by those that are most important to them. Caregivers should ask the nursing staff for help if they are not exactly sure how to go about holding their child due to equipment or bandages.
- Play is a familiar part of every child’s day and can help relieve tension for both children and caregivers while providing a distraction that helps the child feel better. Talk to the child’s nurse or doctor about when it is okay for the child to be out of bed. If the child will be staying at CHOC in an inpatient room, our nurses and child life specialists will be happy to provide you with age-appropriate books and toys.
- Music can be very comforting and has been shown to relieve muscle tension. Families are welcome to bring personal MP3 players with headphones for the child to listen to while preparing for and recovering from surgery.
- While at CHOC, ask to speak with a child life specialist who may be able to offer additional coping strategies for your child.