Pain management that works well means the child will become active again more quickly, which helps both healing and recovery.
Staff will try to prevent pain, will assess the need for pain relief, will give the pain relief needed, and will check it has worked well. As a parent or guardian, you can help by telling us when you think your child is in pain, and whether the effects of pain relief enough.
Pain relief will be started at an early stage. This is done to build up a level of pain relief in the blood which means that the body's own reactions to pain are reduced and often less pain relief is needed. To maintain even concentrations of medication in the body, to achieve the best effects and avoid “pain peaks”, your child will also receive pain relief regularly, even if they do not appear to be in pain just then. By providing pain relief regularly and preventing pain flare up, smaller amounts of medication often need to be administered. This also reduces the risk of side effects such as constipation and nausea.
A combination of medications that work in different ways and different ways of administering these is often used to achieve the best possible results with pain management.
It is common to provide pain relief directly into the blood stream via an intravenous access. In this case, the medication can be administered both as injections or as a continuous infusion via a medicine pump. Pain relief can also be given orally as tablets or in liquid form.
Pain relief with a local anaesthetic means that the medication is applied to or injected under the skin as individual or repeated doses or via drops. Local anaesthetics prevent pain transmission in the nerves that serve the area where the medication is used. The numbing cream, that the child is given before the cannula is inserted, is a form of local anaesthetic.
In the case of pain relief with the help of a nerve block a local anaesthetic is injected close to an area with a bundle of nerves in order to interrupt or block signals travelling along the nerve. A nerve block can be given both as a single treatment or via the insertion of a thin tube through which medication can be administered during and after the operation.
An epidural is an example of a nerve block where an anaesthetised child has a thin tube inserted in their back. When an epidural is used, the anaesthetic can affect the bladder in many cases, which means the child is not aware when they need to urinate. In most cases, the child will also have a urine catheter. This is a tube that can mean the child feels a need to pass urine even when their bladder is empty. An epidural can also affect the strength and feeling in legs. It is important that the child is told about this and that the thin plastic tube will not cause any hindrance to moving or lying on their back in bed.
Morphine is commonly used for pain relief in the case of more serious surgery or injuries. Addiction does not happen when morphine is used as part of pain relief. If your child has been given morphine doses over a longer period, the dose will gradually be reduced to avoid pain flare ups and withdrawal symptoms.