Managing Pain after Surgery

Yes, this is a big operation, so it's normal to expect some pain afterward. Don’t worry—you’ll be given strong pain medicine during the operation while you're asleep, and you’ll continue to have different types of pain relief for at least the next two weeks to help you feel better.

The first two days after surgery are when the pain will probably be the worst, but you’ll get strong pain medicine through a drip (called a cannula) to help manage it. Some of these pain medicines are called Ketamine and Fentanyl.

Strong medicines can sometimes make you feel sleepy, sick, or itchy, and might make you not feel like eating, so we only use them for the first couple of days, when the pain is usually at its worst.

After those first few days, you’ll switch to regular pain medicine that you can take by mouth, either as tablets or syrup. You’ll continue to take these for the next three to four days, and you’ll also go home with some pain medicine to help you feel more comfortable.

The painkillers will help ease the pain so you can move, rest, and sleep better, but it’s normal to still feel some soreness or discomfort. Starting to move around (from the day after your surgery), using pillows, or even heat or cold packs can help. Doing things you enjoy, like listening to music or watching TV, can also distract you from the pain and make you feel better.

For the first few days after your operation, you’ll take a combination of strong pain medicine to keep you comfortable. Your anaesthetist, nurse specialist, someone from the Children’s Pain Team, or your nurse will talk to you and your family about the types of pain relief you’ll be given and show you the machine that helps give you the medicine.

You’ll usually have a Fentanyl infusion for at least the first two days after the operation. This means the medicine will be given to you through a drip – a small plastic tube in a vein (a patient-controlled infusion, PCA). You’ll also likely be given a Ketamine infusion during this time, which works together with the Fentanyl to control your pain.

Along with these medicines, you’ll be given regular doses of Paracetamol and Ibuprofen. When these medicines are used together, they help control the pain better, and you’ll need less of the stronger medicines, which also means fewer side effects.

You might also be given Diazepam to help if you have muscle spasms (this is when your muscles suddenly move, and you can’t control them).

The Ketamine and PCA infusions are usually stopped after two days. After that, you’ll likely switch to a slow-release Morphine that lasts 12 hours, along with extra Morphine tablets or syrup for any breakthrough pain. You’ll usually take the slow-release Morphine for two days, along with regular Paracetamol and Ibuprofen. You’ll also go home with some Morphine tablets or syrup to help manage the pain.

Patient-controlled analgesia is a way for you to give yourself more pain relief medicine when you need it. Everyone feels pain differently, so with this system, you can press a button whenever you feel uncomfortable to control how much pain medicine you get.

How it works:

1. Press the button on the machine’s handset.

2. The machine beeps and gives you a small dose of medicine through your drip.

3. The machine then “locks out” for 6–10 minutes to prevent too much medicine.

4. After that time, it works again when you press it.

Only you should press the button. If it’s not working or your pain isn’t controlled, tell your nurse.

 

 

 

 

 

 

Note: this is an example of a machine, the hospital may use a different version and will explain to you how it works before you use it

Fentanyl and Morphine

• Common: feeling sick, vomiting, itching, constipation

• Rare: slow breathing – tell your nurse if you’re worried

Ketamine

• Usually very few side effects

• In high doses: hallucinations, confusion, double vision, sleepiness, increased heart rate or blood pressure

If you feel strange or unwell, let your nurse know.

While on PCA and Ketamine, your nurse will check you hourly. They will monitor:

• Pulse and breathing

• Pain relief used

• Your pain score from 0–10 (0 = no pain, 10 = worst pain)

Please tell us honestly how you feel — we want you to be comfortable.

 

Start moving early
Moving from the day after surgery can:

• Reduce stiffness and pain

• Help your bowels

• Lower risk of chest infections or clots

Physios and nurses will help you start.

Stay active
Physiotherapists will help you:

• Get out of bed

• Walk, climb stairs

• Use TED stockings or Flowtrons (leg squeezers)

You might need daily injections to prevent clots if you’re older or higher risk.

Eat and drink
Hydration and eating help you recover. If you feel sick, tell your nurse — they can give anti-sickness meds.

Constipation
Caused by pain meds, less food/drink, lack of movement.
You’ll be given medicine to help poo, and encouraged to stay active.

Stay busy
Read, do puzzles, listen to music or watch TV — distraction helps.
We’ll also teach breathing techniques and pillow positioning for comfort.

We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment, speak to a staff member or contact PALS:

• Freephone: 0800 183 0204

• From abroad: +44 115 924 9924 ext 85412 or 82301

• Text (Deaf/Hard of Hearing): 07812 270003

• Email: nuhnt.pals@nhs.net

• Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614, Nottingham NG7 1BR