Advice on Pain Relief following Multi-Level Surgery

Pain and Sedation Service

Advice_on_Pain_Relief_following_Multi_Level_Surgery_PIAG_065 (312kB pdf)

Introduction

Following multi-level surgery, good pain management is a priority, not only immediately after the operation, but also after discharge home. During the weeks after surgery, your child will require periods of intensive physiotherapy. It is important to maintain good pain relief during this time so that your child can participate in the necessary exercises to aid their recovery.
Details of the operation your child had are included on a separate sheet.
Your child will be discharged home with a combination of pain relieving medicines.
These medicines are listed below.

This is the most widely used pain relief medication. It can be used alone or in combination with other pain relief medications. Do not give your child more than 4 doses of paracetamol in 24 hours.

NSAIDS such as Ibuprofen or Diclofenac work by reducing swelling and inflammation. This is particularly helpful after surgery. Only one NSAID will be given to your child, either Ibuprofen or Diclofenac, not both. NSAIDS can cause indigestion and heartburn which could make your child feel sick, so it is important that your child takes NSAIDS with or after food. While your child is taking a NSAID regularly, a medication will be given for your child to take at home that reduces
the amount of acid in the stomach, so reduces symptoms of heartburn and indigestion.

• This is a type of pain relief medication known as an ‘opioid’. It is used to treat moderate to severe pain. It has shown to be more effective when given at the same time as paracetamol.
There is a possibility that Tramadol can cause constipation (difficulty doing a poo), therefore laxatives will be given for your child to take at home while he/she is taking these pain medications. Laxatives will make your child’s stool (poo) softer and easier to pass.

This is another type of opioid and it is used to treat moderate and severe pain. Only one opioid medication will be given to your child, either Tramadol or Morphine, not both. There is a possibility that Morphine can cause constipation, therefore laxatives will be given for your child to take at home while he/she is taking these pain medications. Laxatives will make your child’s stool (poo) softer and easier to pass. Most children get constipation when taking morphine.
Encouraging your child to have plenty of fluids will also help.

Immediately after discharge from hospital

Your child will continue to need regular pain relief. Paracetamol, an NSAID and an opioid can all be given at the same time, if required.
Do not wait for the pain to get bad before giving your child their pain relief medication. It is best to try and give pain relief before pain starts. You should not worry about giving your child medicines to make their pain less. Your child will feel much better if they are not in pain.
However, it is important to follow the instructions on the bottle / packet and that you do not give the medicine more often than the instructions advise. To keep track of the pain relief medicine your child has received, and when you gave it, you may find it helpful to record the details in a timetable.
Children can express how much pain they feel in many different ways. In general, you should give pain relief for as long as your child is complaining of pain. If you have any concerns about how long you should continue giving your child pain relief medicine, you can contact Lara Pearn or Kristine Gatti on 0151 252 5949.
When your child does not seem to need regular pain relief, you should start to miss out some of the doses. You should continue to give pain relief about one hour before any physiotherapy, so that the pain relief is working during and after the session.
Please read any information leaflets that come with the medicines for advice (additional
information can be found at https://www.medicinesforchildren.org.uk/search-for-a-leaflet).

General information about side effects of medicine

A side effect is an unwanted reaction or symptom from a medicine, sometimes called an ‘adverse drug reaction’. All medicines can have side effects. If your child experiences any side effects, it is important to discuss this with a doctor or pharmacist so a decision can be made if the medicine should be stopped.
If it is recommended that the medicine should be stopped, an alert will be put in your child’s notes to alert other health professionals that your child should not have this medicine.
Anyone can report side effects of medicines to the Medicine and Healthcare products Regulatory Agency (MHRA). To find out how to make a report, ring MHRA helpline on Freephone 0808 100 3352 or visit their website http://www.yellowcard.gov.uk.
If you are unsure about any medicines, have any questions or you are concerned about your child’s pain in any way, you should contact the hospital for advice. (Staff to complete box below with contact / telephone numbers and availability)

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.
This information can be made available in other languages and formats if requested.