Acute Pain Management

No one likes to experience pain, least of all in an unfamiliar environment, however it is quite normal to experience some pain after surgery. At AWH - Wodonga Campus our aim is to keep your pain at a level that you feel comfortable with. If you are comfortable you will be happier in yourself, be able to sleep, move around more freely and be able to cough and take deep breaths. Too much pain can be harmful and lead to a longer recovery period, whilst good pain relief can enable you get back home and do your normal activities, as soon as possible. At this hospital, your Anaesthetist or Doctor will treat your pain. Your anaesthetist will see you before your surgery and discuss what form of pain relief s/he will give you. S/he may also visit you the day after your surgery to ensure you are comfortable. If you have any concerns you should discuss these with the anaesthetist or surgeon.

How Will I Be Given My Pain Relief?

There are several different ways in which you can receive pain relief; following is a brief outline of the different methods available. Medication may be given during the operation and in the post anaesthetic care unit, so that you will be comfortable when you return to the ward. Medications will be continued at regular intervals once you have returned to the wards depending on which drug you have been ordered. Sometimes you may receive a combination of different medications. It is up to the anaesthetist or surgeon to decide which is the best form of pain relief. Never be afraid to say if your pain is at an uncomfortable level.

Oral Analgesia (pain relief) - you will be given a tablet to swallow at regular intervals. This may be given together with other forms of pain relieving medication.

Intramuscular Injection - you will be given an injection every 3-4 hours into either the arm, leg or bottom.

Subcutaneous (just under the skin) - a small cannula is inserted into the abdomen. Through this, the nurse will inject medication every few hours; this absorbs into the tissues gradually.

Rectally - the nursing staff will insert a suppository into the rectum, or back passage. You may notice a milky discharge once the suppository has dissolved.

Regional Block - whilst in the operating theatre, you will receive an injection near the site of your operation. This will numb the area around the wound for several hours.

Spinal Block - You will receive an injection into your back prior to the commencement of your operation. This will make your feet, legs and abdomen, go heavy and numb. This form of pain relief lasts for approx. 3-4 hours depending on the type of medication used, so your lower limbs will not return to normal until you have returned to the ward.

Epidural Block - this is a very effective way of treating pain following certain types of operations. A small plastic tube (epidural catheter) is inserted into the space surrounding the spinal cord. Pain relieving drugs are then administered via the epidural catheter, using a machine to regulate the rate and dose administered. More information later.

Patient Controlled Analgesia (PCA) - this is also a very effective method of receiving pain relief. A machine containing a pain-relieving drug will be attached to your drip and you will administer the drug yourself by pressing a button whenever you need pain relief. This means of medication works quickly and because you are getting a dose whenever you need it, you are unlikely at get unwanted side effects. (Oral medication may be given at the same time).

What Drugs Will I Be Given?

Drugs such as Morphine and Pethidine are given during or after the operation. These drugs may make you feel sleepy so you may need some oxygen via a mask for a while.

Can I get addicted?

It is very unlikely that you will become addicted to a drug when taking it for pain relief. Please don't let the thought of becoming addicted prevent you from having pain relief. It is more important that you are free of severe pain and can move around, cough and breathe deeply so that you are free of complications from the surgery.

Will I feel nauseated or vomit?

Many people think that strong pain relieving drugs make them feel nauseated but there are many reasons for feeling sick after an operation. Whatever the cause you can be treated, either with a drug to help stop the sickness, or by changing the pain relieving medication.

Panadol is a drug that most people use for mild pain like headaches. However, recently it has been found that using Panadol regularly with stronger drugs provides better pain relief.

The nurses may give you Panadol regularly if ordered by the doctors.

Another drug we use a lot in the first few days is the Anti- inflammatory drugs eg. Naprosyn, Voltaren, Indocid. These drugs are usually used for arthritis but are also very effective for surgical pain when given with Panadol and narcotics.

How Will You Know When I Am In Pain?

To be able to treat your pain effectively, the nurse will need to measure the level of your pain. You will be asked to select a number from 0-10 that best describes your pain, where 0 = no pain and 10 = worst pain imaginable. Everyone's score is personal, because people can score the same level of pain differently. It is often difficult to think of a number when you are in pain. Why not practice now? Think of some time in the past when you suffered pain eg. a bad headache. What number would you use to describe how bad it was? Remember there are no right or wrong answers, it is what you feel. If you have difficulty assigning a number to your pain, there are rulers available that may help. The ruler has a slide indicator that can be moved to any position. The nurse can read a number from the back of the ruler. We also have a video you can watch on the ward while you are waiting to go to theatre; this will help you to understand the pain scoring system we use. Ask the nurses to show this to you.

Patient Controlled Analgesia

After major surgery you may not be able to take tablets straight away, therefore it is important to give you these drugs in a different way. These days we try not to use injections, as they are painful and take a little while to work.

The most common method is to give the strong drugs into your vein through a drip. The most popular method of doing this is to use a special pump and a method called patient controlled analgesia (PCA).

The following explanation will help you understand how it works.

When using PATIENT CONTROLLED ANALGESIA - or PCA for short - you will be able to ensure that you get your pain medication when you need it. You will not have to wait for a nurse to come and give you a pain killing injection or tablet. You will be in charge.

How does a PCA work?

Your doctor or anaesthetist will prescribe medication for you for pain relief and the nurses will program the machine accordingly.

This medication will be administered quickly from a special PCA infuser, or pump by you pressing (and then releasing) a hand held button.

The drug will be quickly absorbed by your body and will start to work almost immediately - usually 3-5 minutes - to ease any pain you might have.

When you have pressed this button, just wait quietly for a few minutes for the medication to start working.

How often can I press the button?

You can press the PCA button whenever you feel uncomfortable. However once the button has been pushed and the PCA machine has delivered the dose, the machine will 'Lockout', or not allow another dose, for 5 minutes. This will allow the dose of medication to work before you can get another dose, regardless of how often you press the button.

Always ensure you are the only one pressing the button. The reason for this is that too much of the pain relieving medication can make you feel sleepy and if you are very sleepy you will not be able to press the button.

Can I get addicted?

It is very unlikely that you will become addicted to a drug when taking it for pain relief. Please don't let the thought of becoming addicted prevent you from having pain relief. It is more important that you are free of severe pain and can move around, cough and breathe deeply so that you are free of complications from the surgery.

Will I feel nauseated or vomit?

There are many reasons for feeling sick after an operation. But whatever the cause you can be given medication to help stop the sickness. If it is thought to be due to the drug in the PCA machine then the dose may be reduced slightly or the drug may be changed to another medication.

For how long will I use the PCA?

You will be able to keep the PCA until your pain is mild enough to be controlled by pain controlling tablets. It is quite common for the PCA to be discontinued once the drip comes out, usually within 24hours of surgery but this need not be the case. If you feel you need to keep the stronger form of pain relief, mention this to the nurses before they discontinue it.

Benfits of PCA

There are many benefits to using PCA and many reasons why it may be preferred over other methods of pain relief.

SAFE
EFFECTIVE
EASY TO USE
PROVIDES INSTANT PAIN RELIEF
ENABLES YOU TO HAVE CONTROL

Points to Remember

Inform a nurse if pain relief is not being achieved.
If you have problems or queries about PCA, its operation or function let a nurse know.
Under no circumstances allow a family member or friend to push the button.
Give yourself another dose as soon as you feel pain.

Avoid waiting for pain to reach an unbearable level. It is much harder to get severe pain back under control.

When you have planned activities such as physiotherapy or when you need to move around, you may find it helpful to push the button five or so minutes prior to the activity and then again at the start of the activity.

Epidural Analgesia

Epidural analgesia is another very effective way of treating pain after major surgery. This involves inserting a fine plastic tube called an epidural catheter, into the space surrounding the spinal cord (epidural space). An anaesthetist in theatre inserts the catheter before your operation. Pain relieving drugs are then administered via the epidural catheter at a constant rate. The epidural catheter may be left in place for several days. In this hospital you will be nursed in the high dependency unit while you have an epidural infusion in place. This is so the nurses can observe you closely therefore reducing the possibility of complications.

What are the advantages in having an epidural?

Having an epidural has several advantages:

It gives good pain relief.
You are less likely to suffer from nausea or vomiting.
It is easier to take deep breaths or cough especially when doing physiotherapy.
No need for repeated injections.
There is less likelihood of any complications such as thrombosis (blood clots in the legs) because you are able to move around a lot more freely.

Are there any disadvantages?

Like most things there are some disadvantages, but they are all treatable, so should not cause you too much discomfort.

You will have some weakness in your legs with pins and needles or numbness, which should subside the longer you have the epidural running.
You may become itchy due to one of the drugs you may be given; this can be resolved by further medication.
You may find you are quite dizzy when you sit up, and suffer with a headache.
It may be difficult for you catch your breath, should this happen, you should report it to the nurse looking after you.
There is a very small risk of nerve damage, but this is very rare.

Relaxation

As well as using drugs to treat your pain there are other things you can do to help. Relaxation and warmth are things that have been found to be very beneficial in relieving pain. After your surgery it is normal to feel a little anxious and tense. When this occurs, you will automatically tense your muscles, especially around the area of your wound. This will lead to an increase in pain and will stop you from moving freely. One way of stopping this from happening is to learn to relax your muscles. Warmth can also help you relax. You may already use relaxation to relieve stress in your everyday life. If so, use it after the surgery. If you have never tried relaxation it would help to practice before you come in to hospital. One simple method is to use breathing techniques. By becoming aware of your breathing you can use it to help you relax.

Remember

Severe pain can lead to complications and a longer recovery time.
Severe pain is harder to treat. Get medication before the pain gets too bad.
Let the nurses know if you are in pain, have difficulty breathing or feel very sleepy.
Getting back to normal as quickly as possible is a top priority.
Ask the nurses to show you the video on Pain Management.