Inpatient Surgical Pain

Many children undergo operations. The amount of pain an operation causes depends on the kind of surgery and the child. In addition to making your child feel unwell, pain after an operation can slow a child's recovery, slow the return of normal bowel function and interfere with breathing and physical therapy.

The first two days after the operation are usually the worst. After that, things usually start to get better. There are many ways to help children be comfortable after surgery. Ask your child's doctor which ones are right for your child and the operation he or she is having.

  • The incision, or cut, that the surgeon made.
  • Muscle spasms, or cramps, which can be very painful after orthopaedic and urologic surgeries.
  • Bladder cramps, which often occur after surgery on the bladder.
  • If there is a tube left in the chest after surgery in that area, the poking feeling inside the chest can be very bothersome.
  • Nasogastric tube (NG tube) can be very irritating to the throat.
  • Air or blood inside the belly or chest, which can cause pain that is felt in odd places far away from the surgical site, such as the shoulders or back. This is called "referred pain."
  • If a child lies on his or her back without moving for a few days, backaches or other muscular aches can become a problem.
  • When an operation is done in the belly, the bowels stop working for a while. When the bowels start to wake up, gas pain can be significant.
  • Muscle aches and other discomforts, which can result from the position the child had to be in during certain operations.

Older children will say they hurt, although sometimes they cannot describe their pain clearly. Younger children may cry, or hold very still and try not to move. Appetite may be poor and children may either sleep a lot or have problems sleeping.

Pain from a surgical incision tends to hurt all the time. Cramps and spasms seem to come out of nowhere and then fade away again. You may or may not see muscles tighten. Your child's nurse or doctor will be able to help sort through some of the unusual ways pain appears after surgery.

For the first day or so, your child will need strong pain medication, usually given through an intravenous line (IV). Once your child feels well enough to eat or drink, medicine can be given by mouth.

The most common strong medicine used after surgery is morphine. Morphine works well for most types of pain after surgery and is safe even for babies. Dosing is done by weight, and your child's doctors and nurses will be watching your child carefully for side effects.

You can expect pain medicine dosage to be regular for the first day or so to keep the pain from getting out of control. It is easier to "stay ahead" of pain then to catch up, and it takes less medicine to keep comfortable. Staying ahead of pain means that you give pain medication before your child experiences the pain at its worst.

There are other similar medicines your child's doctor may prescribe. In addition, non-prescription medications such as acetaminophen (e.g., Tylenol) or anti-inflammatory medicines (e.g., Toradol or ibuprofen) might be used.

You should not worry about your child becoming addicted to pain medication. This would be very rare, unless the child already has a problem with drugs or alcohol. Once the pain begins to get better, most children do not like the way the pain medicines make them feel and they use less and less, even if they are allowed to use as much as they want.

Special types of pain control that are offered to many children include epidurals, nerve blocks, caudal analgesia and patient-controlled analgesia pumps (PCA).

At Cincinnati Children's, the Acute Pain Service provides consultation for more complicated types of pain. The Pain Service staff is available 24 hours a day for patients.

Nurses from the Integrative Care Department provide massages and healing touch. These can help muscle pain and tension, anxiety and stress.

Physical therapy can help get things moving and strong again.

A TENS unit is also sometimes helpful. "TENS" stands for transcutaneous electrical nerve stimulation. This is a palm-sized device that uses a small amount of electrical current to help the body shut down incoming pain messages at the level of the spinal cord. It can be useful for localized pain (pain in a specific area) and has few side effects.

Ask your child's doctor if any of these suggestions might be right for your child.

  • Pain is not controlled
  • Your child is too sleepy
  • Your child is not making sense when he or she talks
  • Your child experiences a lot of vomiting or itching or has trouble urinating

Help your child's doctors and nurses get to know your child. Let them know if you think your child is having trouble telling how he or she feels. Emphasize to your child that he or she does not have to "be brave" or put up with pain.

At Cincinnati Children's, you can expect your child to be made as comfortable as possible. The hospital staff will also try to keep side effects to a minimum. Unfortunately, there are times when a pain or discomfort cannot be made to completely go away. Other times, there will be unavoidable side effects. The doctors and nurses will do their best to make your child's experience the best it can be.

If it has been a while since the last dose of medicine, and you think your child is starting to have more pain, let your child's nurse or doctor know. Again, it is better to stay ahead of pain, meaning that you give pain medication before your child experiences the pain at its worst.

When you go home, your child will receive a prescription for pain medication. Please get it filled right away, so you can continue to "stay ahead" of your child's pain. Some children will have very little pain by the time they go home; others will still need regular doses of medicine for a few days.

Do not give more than instructed. If the medication is not working, call your child's doctor.

Often, getting out of bed and moving around helps the body recover after surgery. Your child's doctor will tell you how much activity is appropriate for your child.

The pain medicine can be used to help allow your child to move around as much as the doctor wants him or her to. Moving about helps prevent back and muscle aches from lying in bed. Also, the bowels wake up faster, and eating can start again sooner. Changing position is the best way to help relieve gas pain after belly surgery.


Last Updated 10/2012