Postoperative Pain Control for Children

How Do You Prevent Pain after Surgery?

As a parent, one of your main concerns is that your child be made as comfortable as possible after surgery. Depending on your child's age and the type of surgery being performed, different options for pain control are available.

You will have the opportunity to discuss pain control with a member of your child's anesthesia team when you come in for your pre-admission testing.

Some options for postoperative pain control include caudal morphine, epidural catheter, a patient-controlled analgesia (PCA) and intravenous infusion of narcotics.

Caudal Morphine Injection

A technique that may be used for infants older than 6 months and young children whom we plan to wake up soon after the completion of their operation.

A small dose of morphine is injected into the epidural space (the space outside the spinal cord and its coverings) at the level of the tailbone.

The injection is done as a sterile procedure and is performed after your child is under general anesthesia. The dose of morphine is based on your child's weight and is smaller than an intravenous dose of morphine needed to give equivalent pain relief.

The pain relief provided can last 18 to 24 hours. If your child is still uncomfortable, small doses of intravenous pain medications may be given as well while your child is in the Cardiac Intensive Care Unit.

Itching and nausea are the most common side effects of many pain medications regardless of how they are given. If your child develops either of these side effects, medications may be given to relieve them.

Epidural Catheter

A pain control option commonly used in children undergoing a thoracotomy. A thoracotomy involves an incision on the left or right side of the chest and is usually more painful than an incision through the sternum (breastbone). A common procedure performed through a thoracotomy is an aortic coarctation repair.

An epidural catheter can be placed in children of any age, but is commonly used in children over a year of age who are likely to not need a ventilator for very long after surgery. Depending on the age of the child, the epidural catheter is placed while the child is sedated or completely under general anesthesia.

The epidural catheter is placed using a needle which is inserted in the back and slowly advanced until the correct space is located. This space is different than the one used for a "spinal tap." Once this space is located, a small flexible catheter is inserted and allows for medications to be given directly into the epidural space. Local anesthetics and narcotic medications are given to your child which block the transmission of "pain signals" from the surgical area to the spinal cord.

Children with an epidural catheter will usually have excellent pain control, better control of hypertension after aortic coarctation repair, and appear less sedated than patients receiving narcotics through an intravenous line. The Cincinnati Children's Department of Anesthesia has a pain team that is available 24 hours a day and will care for your child's epidural following surgery.

If your child is a candidate for an epidural catheter, an anesthesia team member will speak to you about this option, including risks and benefits, during the preoperative visit.

Patient-Controlled Analgesia (PCA)

A pain control option for children who are older than age 7 and are expected to be awake at the end of the surgery. In this case, a special pump will be hooked up to your child's intravenous line.

Your child will be given a button to push whenever the need for pain medication arises. The pumps are specifically programmed based on your child's weight, and it is not possible for children to overdose themselves.

It is important that your child is the only one who pushes this button. You can, however, encourage the child to use the button when necessary.

Morphine is the most commonly used medication for patient-controlled analgesia. However, if a child develops excessive itching, nausea or other side effects from morphine, your doctors may change the patient-controlled analgesia to a different narcotic.

All narcotics can cause itching and nausea. However, there are usually one or two narcotics that a patient will tolerate better than others. Once your child is able to eat, it is possible to replace the intravenous pain medication with oral (by mouth) pain medication.

Intravenous Administration of Narcotics

Used for many infants and children undergoing surgery for repair of heart disease who are too young or too sick to use the pain control methods described above. In this case, your child will be given intravenous pain medications either intermittently or as a constant infusion.

Your child's anesthesiologist, surgeon, and Cardiac Intensive Care Unit doctor will decide which medications will work best and how they will be given based on your child's condition.

Many parents worry about children becoming "addicted" to the pain medication. All evidence indicates that short-term use of narcotics to treat painful conditions does not lead to addiction.

Some children need pain control for longer periods of time (more than a week). In this case the child's body gets used to the narcotic so higher doses are needed to achieve pain control. This pattern is NOT addiction but a physical process called tolerance.

If tolerance develops, the pain medicine cannot be stopped all at once. The dose is gradually reduced over time so that the medicine can be stopped safely.

Last Updated 01/2013