How is Pain Managed After a Procedure?

Pain and discomfort after a procedure (surgery) is common and expected. Most pain or discomfort can be decreased to improve your child’s comfort and help them rest.

Pain relief medicine and/or comfort methods may help to reduce your child’s pain. The care team (providers and nurses) will do their best to help your child feel better, but your child will likely still have some pain and discomfort. Pain relief medicine may need to be limited to reduce the risk of side effects.

There are many ways to improve your child’s comfort. This handout provides info and tips that may help manage your child’s pain and discomfort.

Please be an active partner in your child’s pain management plan by:

• Helping us assess and treat your child’s pain
• Telling us what comforts your child

Pain

Pain is an unpleasant feeling or discomfort. How much, how long, and what type of pain or discomfort each child has depends on the child and the procedure.

Pain is often worse in the first few days. Pain can be:

• Mild, moderate or severe
• Sharp, dull, burning, spasm, throbbing, stabbing, pressure, aches or gas
• Clearly seen or harder to notice depending on your child’s activity level, sleep and eating patterns
• Short-lasting, every once in a while, or long-lasting

Pain from a surgical incision (surgery cut) tends to hurt all the time. Cramps and spasms seem to come out of nowhere and then fade away again. Other general pains such as sore throat or headache are common for the first 24 hours.

Pain Measure

Children can have pain and not show it very clearly. We will ask your child how they feel. If your child is too young or not able to answer, we will ask you how you think your child is feeling. As a parent, your point of view on your child's comfort is very important.

Pain scales also help measure the amount and type of pain that your child is feeling. The care team will select and review the pain scale for your child based on their age and level of development.

Two types of pain scales that may be used are:

• Observation (watching their behaviors)
• Self-reporting (asking them to use pictures of faces or a number scale to rate their pain)

Why is Managing Pain Important?

Pain can slow your child’s healing process. Pain can affect your child’s:

• Ability to cough or deep breathe
• Sleep and energy levels
• Ability to eat like normal
• Mood

These changes may increase your child’s risk for other problems.

Research shows that children whose pain is well controlled get better faster and have less problems and lasting effects.

During the Procedure

Your child’s care team will make your child a customized (special for your child) anesthesia plan that includes pain relief medicine. Your child’s plan depends on the procedure and your child’s medical and psychological condition. The care team will explain how the pain relief medicine and other pain treatments work.

Your child may get pain relief medicine such as:

• Opioid (narcotic) through an intravenous line (IV) or by mouth (e.g. fentanyl or morphine)
• Non-opioid pain relief medicine through an IV or by mouth
• Regional or nerve block (numbing medicine)

Pain relief medicine can cause side effects. The care team will try to reduce these side effects as much as possible. Sometimes side effects cannot be avoided.

Many pain relief medicines may decrease how often and deeply your child takes a breath. Your child’s care team may need to limit these types of medicines to reduce the risk for breathing problems. To help stop these side effects and avoid addiction, only take these medicines under your provider’s care. Your child’s care team has the skill to safely give these medicines.

After the Procedure

Your child may have pain even though they were given pain relief medicine during their procedure. Some children need extra pain relief medicine in the Post Anesthesia Care Unit (recovery room). As the pain relief wears off, your child may need to keep using pain relief medicine and comfort methods in the hospital and at home.

Since no child is the same, the type of pain relief medicine and how long it is needed will vary. Ask your child’s care team about your child’s pain management plan.

In the Hospital and While at Home

Some things that may help your child be more comfortable:

• Find a relaxing position: Try using blankets or pillows to help create a comfortable space. Hold or rock your child as allowed by your child’s provider.
• Distract with activities. Help keep your child’s mind off the pain with music or quiet activities. Suggestions for activities are watching a video or using hand-held electronics.
• Distract with conversation. Talk about things not related to the hospital or surgery (friends, favorite movies, favorite toys or games, their pets or school).
• Use humor. It can improve your child’s mood and change their attention.
• Talk about ways to cope. “If you do this _____, you will get better.”
• Encourage relaxation techniques. Try deep and steady breathing or meditation.
• Use cool or low heat. Ask your child’s provider if a cool or low heat source is allowed.

Your child’s provider may also suggest a pain relief medicine for home. They may:

• Tell you to use over-the-counter (OTC) pain relief / fever reducing medicine
• Give you a prescription for pain relief medicine:
  • Fill your child’s script right away.
  • Ask the care team when your child can start this medicine.
  • Do not use this medicine if your child is too sleepy.
  • Do not wake them up to give this prescription medicine.

When giving medicine at home, follow the instructions on the bottle.

• Do not give more medicine than instructed.
• If you are not sure if you are giving the right amount or if you are giving it the right way, call your child’s provider.

Pain relief medicine may work better when given before your child’s pain is at its worst. Your child’s pain may increase if you are trying to wait or not give pain relief medicine. It can be very hard to reduce pain after it has become moderate or severe.

Use the pain scale handout “Parent’s Postoperative Pain Measure (PPPM)”, which may be given to you before discharge, to help you measure the amount of pain your child is having. The score will show you when they may need their pain relief medicine.

Your child’s provider may limit or suggest activities that promote healing. While taking pain medicine such as an opioid:

• Assist them when they walk or crawl.
• Assist them when going up and down stairs.
• Do not let your child drive or use heavy machinery.

Call Your Child's Provider if Your Child:

• Has pain that prevents them from being able to rest, sleep, or be comforted
• Is overly sleepy, and you cannot wake your child easily
• Is not making sense when they talk
• Has side effects such as an upset belly, throwing up, itching, trouble peeing or pooping

Concerns about Addiction

It is rare for a child to become addicted to pain relief medicine. Long-term use of opioid medicines can be addictive. It is best to talk to your provider if you have concerns about this due to the child or a family member with addiction problems.

Cincinnati Children’s Pharmacy

Prescriptions can be filled in our outpatient pharmacy locations at Burnet and Liberty campuses. Pharmacy hours vary by location. The pharmacy:

• Accepts most insurance plans
• Is a cashless system (accepts credit and debit cards)
• Carries some over-the-counter medicines such as acetaminophen (Tylenol®)

Safe Medicine Storage and Disposal

Storage

• Lock up opioid medicine in a safe place.
• Keep medicine in original package.
• Keep track of how much medicine you have (count it).
• Always use a child-resistant cap.
• Relock the cap after each use.
• Keep medicine away from children and animals.

Disposal

Dispose of unused opioid medicines right away. Do not save the medicine for future use. This avoids possible misuse, abuse, and intake by accident.

If a medicine collection program is not available, follow these steps:

• Visit www.fda.gov/drugs. Search for “disposal” to find the Safe Disposal of Medicines page.
• The safest way to get rid (dispose) of medicine is to drop it off at a medicine collection site. Call your local pharmacy to see if they have a medicine collection program.
• If a medicine collection program is not available:
• Use an opioid disposal kit (check your local pharmacy).
• Flush the unused opioid medicine down the toilet.