Services & Specialties
Perioperative Pain Management

What is Perioperative Pain Management?

A caring team of doctors, nurse practitioners, and nurses will work together to help manage pain after surgery. For less painful procedures, the anesthesia and surgical teams will take care of pain control, but for more painful surgeries, the perioperative pain management team steps in with their special expertise.

Before surgery, we talk with children and their families to create a pain management plan and make sure they’re comfortable during recovery. We work closely with other teams, like those in integrative care, surgery, nursing, and physical/occupational therapy, to make sure everyone has the support they need after surgery.

It’s also important to know that getting ready for surgery starts well before the procedure itself. Healthy habits like getting enough sleep, eating nutritious foods, staying active, and practicing relaxation techniques like deep breathing can help with pain management and make it easier to get back to normal activities after surgery.

A Culture of Managed Pain

Pain is unpleasant. But worse, it can interfere with recovery from surgery or illness, prevent normal activity and affect a child’s quality of life. One of the hardest things about pain is that even the best treatments do not guarantee that pain will be eliminated.

Patients and medical staff may wish for no pain after surgery, but it's important to understand that trying to completely eliminate all pain can sometimes lead to problems. Treating pain too much can be just as tricky as not treating it enough. Our goal is to keep pain at the lowest level possible while making sure it’s safe, even if that means there might still be a little discomfort.

We focus on each child’s unique needs when it comes to managing pain. We take into account the condition, how it’s affecting the child’s life, and the doctor’s plans for treatment. Together with the doctors, your child, and your family, we create the best plan to manage pain and help everyone feel as comfortable as possible.

Perioperative Pain Management FAQ's

Depending on the surgery, the child's condition and medical illness, and surgeon requests, we will usually see you before surgery to formulate our plan and discuss the risks/benefits of medications/procedures we can offer to help with your child's pain.

Intravenous "I.V.": Pain-relieving medications that are injected into a vein which help decrease pain, for example, IV opioids – these medicines help with pain, but may have other side effects like nausea, itching, drowsiness and can affect breathing.

Oral Medications: Pain-relieving medications taken by mouth help to decrease pain. They are usually taken every 4-6 hours. The pain relief usually lasts longer than with IV medications. These medications are prescribed once one can tolerate eating and drinking regularly.

Local Anesthesia: Other pain-relieving medications may be injected into the surgical incision by their surgeon. These medications are local anesthetics. They provide numbness or loss of sensation in a small area.

Regional Blocks: Regional blocks can reduce the pain after surgery and can provide either analgesia or anesthesia. Local anesthetics and other drugs are used for these procedures to reduce or "block" pain and other sensation over a wider region of the body.

This means using different medications which tackle pain in different ways. This is because pain after surgery can have different reasons. It is believed that pain has not only a sensation component, but also a “worry” component. In general, stress and pain coping may be different depending on whether the child is a “worrier” or anxious. Another aim of our pain management is to minimize need for opioids without compromising pain control. The different kinds of medications and approaches we use for helping with pain after surgery are summarized below:

  1. muscle relaxants to help with muscle cramps
  2. medications that help with inflammation and reduce the need for stronger medicines like narcotics
  3. opioids to treat severe pain
  4. nerve-soothing agents
  5. medications for anxiety
  6. For some procedures, we offer nerve blocks and epidurals, which helps reduce pain by numbing the nerves that supply the painful area, and thus help recovery and decrease the need for sedating medications.
  7. Integrative care and holistic health are our partners in helping with pain coping. They provide relaxation techniques which help your child cope with pain. The surgical/pain team will consult them if they think their services will help your child. Please ask your providers about this if you want to have them involved.
  8. Physical therapy and occupational therapy also play an important role after some surgeries to help your child regain their function after surgery
  9. We sometimes also ask for behavioral medicine to help assess and manage anxiety symptoms as they play an important role in worsening pain.

Pain is not just physical. It causes stress and suffering, and depression and anxiety can result from pain or make it worse.

The entire family is affected by this stress, and addressing this issue is important to your child’s recovery.

In addition, there are pathways in the brain and spinal cord whose job it is to suppress pain.

Sometimes, we or the surgical service places referrals to integrative care and/or behavioral medicine (pain psychology) to help with coping skills for the entire family to improve pain management. Integrative care group consists of a team of healthcare professionals, including child life specialists and assistants, creative arts therapies (art and music therapy), holistic health specialists, media specialists, and recreation therapists, who provide outstanding patient and family-centered holistic care to optimize healing and wellness for patients and families. The techniques they use include massage, breathing techniques, etc. In addition, our psychologists can help your child harness these neurologic defenses to reduce and manage his pain.

Cincinnati Children’s is a leader in pediatric pain research. We work with other leading institutions to develop clinical trials that advance the understanding of pain and pain management therapies.

Current research initiatives include:

  1. Evaluation of psychosocial, genetic and epigenetic factors influencing acute post-surgical pain and chronic postsurgical pain after surgery
  2. Pharmacogenomics of opioids – optimizing the dosing of opioids.
  3. Evaluation of preoperative mindfulness interventions for pain coping and anxiety in children undergoing major surgery

In addition, the Pain Management Center is one of only two ACGME-accredited pediatric pain fellowship programs in the country and is a major training site for pediatric pain psychologists. Lectures for pediatric residents, observerships for practicing physicians, and multidisciplinary pain seminars are also conducted routinely.