Post-operative pain relief

Many parents worry that their child will be in pain after surgery. While this a normal concern, we care very much about the comfort of children after surgery and will do everything possible to minimize their discomfort. Several methods of pain relief are available according to the type and extent of the surgery. For minor surgery–when children are expected to go home the same day-the anesthesiologist gives medication for pain during surgery so children tend to wake up with little if any discomfort.

Simple comfort pleasures such as cuddling with a parent or having a familiar and loved toy or stuffed animal nearby can sometimes help ease a child's pain.

For smaller, more superficial procedures such as the removal of a mole or lump, the anesthesiologist may ask the surgeon to numb the incision site with local anesthetic during the procedure. Sometimes, the anesthesiologist will perform a nerve block-–the injection of local anesthetic close to the nerve that supplies sensation to the incision site while the child is still asleep. This numbs the area of the operation and can give hours of post-operative pain relief without the need for further pain medication. For certain procedures in the groin area, or of the legs, your anesthesiologist may offer you the option of a "caudal block." This block is especially useful for children having hernia repairs, urological surgery such as hypospadias repair, or orthopedic surgery on the lower limbs such as club-foot repair. After the child is asleep, the anesthesiologist inserts a small needle into the caudal space, which is located at the base of the tail bone. Local anesthetic is then injected and the needle removed. The dose of local anesthetic used blocks only the pain signals; the child is still able to move his or her legs. For major surgery that will require admission to the hospital afterwards, additional means of pain relief are available.

Your anesthesiologist may prescribe a PCA machine for several days or offer the option of an epidural block. In an epidural block, a needle is placed between the vertebrae of the lower back into a space called the epidural space. A small catheter is then threaded through the needle into the space and the needle removed. The catheter is then taped in place so it doesn't move. Local anesthetic solution or a combination of local anesthetic mixed with a low dose of narcotics can then be injected through the catheter or a continuous infusion can be maintained for several days. An epidural provides excellent pain relief for hip surgery and major abdominal surgery.

Though an epidural in adults is often performed prior to the surgery while the adult is still awake, in children it is done after they are anesthetized because it is difficult for them to lie still. After your child is awake and is in the recovery room, the recovery room nurse and the anesthesiologist work together to ensure that the child is as comfortable as possible. By the time you leave the hospital, any pain your child has should be easily treated with simple analgesics that your child can take by mouth such as Tylenol or Tylenol with codeine. Children also benefit from simple comfort measures such as cuddling with a parent or having a familiar and loved toy or stuffed animal nearby. Continue reading for more information about pain and what you can do.

What can you do
Pain is an unpleasant feeling that comes with physical injury, damage or disease. An example of pain is a cut or "shot." Some pain, such as a headache, may occur without obvious damage to the body. Untreated pain causes anxiety, depression, irritability (crabbiness) and exhaustion. Pain can slow healing. Our staff's goal is to make sure that all patients are given the best level of pain relief that can be safely provided.

Facts about pain:

• Pain medicine should be used to keep pain away and stop pain before it gets worse.
• The best way to measure pain is to ask the child how much he or she hurts.
• Children as young as three years of age may be able to tell us about their pain.
• Besides the children themselves, parents can best recognize when their child is in pain. We rely on you to help us know about your child's pain and how well we are treating your child's pain.

Ways to tell when your child is in pain can include:

• Becoming quiet
• Having trouble sleeping
• Eating or drinking less than usual
• Complaining about pain
• Being restless or not wanting to move at all
• Holding the area that hurts
• Not sleeping well
• Becoming irritable, angry, whining or not able to be calmed

Children sometimes watch television or play as a way to distract them or help forget about their pain. This does not mean they are not in pain. If a child says he or she is in pain or wants pain medicine, then he or she should be believed.

Some Ways to Help
Children need to honestly be told if a procedure or test will be painful with a description of what they may feel. For example, "this may sting for a minute" or "this may feel cold and then pinch." Giving children choices can help lessen anxiety and pain of some painful procedures. This may be as simple as choosing which finger is stuck with a needle or whether they sit on their parents' lap or on an exam table for a shot. Other ways to help your child can include:

• Bring favorite toys, books or blankets from home.
• Keep the room quiet for rest periods
• Use hot or cold packs
• Distract your child with a favorite video or game
• Hold your child's hand
• Approach your child in a calm, comforting way Share with your child's nurses and doctors what has helped your child in the past when he or she has been in pain. If you have any questions, feel free to call your doctor or nurse.