Managing Pain after Surgery

Yes, this is a big operation, so it's normal to expect some pain afterwards. Don’t worry though,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 (you can learn more about them in the “What painkillers will I be given?” section). 

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.

The medicines we use after this surgery include Ketamine, Fentanyl, Morphine, Gabapentin, Diazepam, Paracetamol, and Ibuprofen (you can find more information in the sections below). 

If you have any questions or worries about your pain or the medicines you’re taking, just ask your anaesthetist, The Children’s Pain Team, your nurse, or your doctor – they're here to help you.

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. If you have any questions, feel free to ask!

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 can find more details about these in the other sections. 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 (pain that happens in between doses). 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 attached to a handset on the machine pump. 

2.    The machine will beep and give you a small amount of medicine through a plastic tube into your vein. Press the button when you feel like you need to.

3.    The machine will 'lock out' for a certain amount of time, usually between 6 to 10 minutes. During this time, the machine won’t give more medicine, even if you press the button again. It will still beep, but no extra medicine will come through.

4.    Once the “lock out” time is over, the machine will work normally again when you press the button.

The “lock out” feature keeps you safe by making sure you don’t get too much pain medicine. No matter how many times you press the button, you won’t receive more than a safe amount. It’s really important that only you press the button. If you think that the PCA is not managing your pain or the machine isn’t working properly, ask your nurse for help.

 

 

 

 

 

 

 

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

This is a photograph showing the bedside Fentanyl PCA and Ketamine pumps and monitor used to measure your heart rate, blood pressure and oxygen levels

Fentanyl and Morphine

·         Some common side effects of the pain medicine are feeling sick, being sick, feeling itchy, and constipation (difficulty having a poo). You’ll usually be given medicine to help with this.

·         Slow breathing is a less common side effect. If you notice any of these symptoms or if you’re worried about anything, make sure to tell your nurse right away.

Ketamine

·         When Ketamine is used in small doses, it usually has very few side effects. 

·         In higher doses, it can sometimes cause things like seeing or hearing things that aren’t there (hallucinations), feeling confused or dizzy, double vision, feeling very sleepy, or having a higher heart rate and blood pressure.

If you feel strange or are worried about how you’re feeling, tell your nurse right away. Your family can also let the nurses know if they’re worried about you.

While you have a patient-controlled (PCA) infusion and a Ketamine drip, your nurse will check on you every hour. They’ll check your pulse, breathing, how much pain medicine you’ve used, and ask you how much pain you’re feeling.

To help the nurses understand how you're feeling, they’ll ask you to rate your pain on a scale from 0 to 10, where 0 means no pain and 10 means the worst pain you can imagine. 

It’s really important to let the nurses know how you’re feeling, even if you’re shy. We want to make sure you’re as comfortable as possible.

It might sound strange, but it’s important for you to start getting up and moving around as soon as possible after your surgery. 

Why? 

If you don’t move around, your muscles can get stiff, your pain might get worse, and you might have trouble going for a poo (constipation). 

Not moving can also increase the risk of a chest infection or blood clots in your legs. 

You’ll start moving around the day after surgery, and the nurses and physiotherapists will help you. 

The sooner you get up and start moving, the sooner you’ll be ready to go home.

Keep active

Your physiotherapist will talk to you about exercises and help you get out of bed. They’ll also help you build confidence with walking and going up and down stairs.

You’ll probably have pressure stockings (TED stockings) or "Flowtrons" wrapped around your legs. These squeeze your calf muscles to prevent blood clots until you’re moving around like normal. Sometimes a daily injection is needed to prevent clots, but your doctor will explain this if needed. It is normally given to older children or young adults or people with a higher risk of developing a clot.

Eat and drink well

It’s important to start eating and drinking plenty of fluids as soon as you feel up to it. This helps your body heal, gives you energy, and helps prevent constipation.

If you don’t feel like eating or drinking because you feel sick, let your nurse know. You might need a different anti-sickness medicine to help with this.

Constipation

Constipation is very common after a big operation. This happens for a few reasons: the strong pain medicine; not eating or drinking as much as usual; not being as active; and feeling uncomfortable using the toilet in an unfamiliar place.

You’ll usually be given medicine to help you poo for the first few days after surgery, along with encouragement to stay active and eat well.

Keep busy

Keeping yourself busy is a useful way to distract yourself from any discomfort you are feeling. You can read, listen to music, do puzzles or watch something to help you think about something else. We’ll show you breathing techniques that can help with pain too and show you how to position your pillows to find the right position for you. 

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