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For most of the 30,000 procedures done every year at Cincinnati Children’s, the primary physician or surgeon can take care of the discomfort from the procedure. However, a number of surgeries and procedures require expert care for associated acute pain.
The Acute Pain Service cares for children who have undergone surgical operations or who have come to the hospital with painful illnesses. We specialize in taking care of pain in infants, children and young adults. Our goal is to keep them safe and comfortable. We design a pain treatment plan to fit the overall care plan that the surgeon or pediatrician has for your child. Although eliminating pain after surgery would seem ideal, it is frequently not a desirable goal; the side effects of pain medications and the associated complications can interfere with recovery. Good pain care reduces the pain to a level that allows the patient to sleep reasonably at night, be alert during the day and participate in recovery activities to the greatest possible extent. If your child is having surgery or has a medical condition that requires extra attention to pain control, your surgeon or doctor can contact a member of the Pain Service to help.
A physician from the Pain Service will usually meet with you and your child before surgery to discuss options for keeping your child comfortable after the procedure. Some of the treatments include:
Other treatments include medicines that can be given by intravenous (IV) line or by mouth. We do not use intramuscular injections (shots) to give pain medicines. The Pain Service physician will discuss options that are reasonable for your child and her medical situation. The doctor will set up the type of pain treatment you agree on. If your child is in the hospital with a painful medical condition, your doctor can call the Pain Service.
An epidural catheter is one that is placed between the bones of the spine and the spinal cord to continuously inject pain medications. Many people know this treatment as one often used for women during labor and delivery. Epidurals may be used from the day of birth onwards. Medications can be given as an infusion through the epidural to keep children comfortable after surgery. They are most often placed while the child is asleep. That way, the child is not scared, does not feel the procedure and does not move (which could cause problems). The epidural medication is started in the operating room. This often allows the anesthesiologist to use less anesthesia, which may help your child to wake up faster and more comfortably. Adjustments are made in the recovery room, and the epidural medication is continued for the next one to five days, depending on the surgical care plan.
Our team members visit your child every day to make sure pain is safely and effectively controlled, and to answer questions you have about pain and its treatment. A member of the Pain Service is available by phone 24 hours a day, seven days a week. Your nurse will know how to reach us in case there is a question or concern about your child’s care. The PCA or epidural is most commonly used for the first few days after surgery, but we will be involved as long as our help is needed. For children with painful medical conditions, a PCA pump can be set up in your child’s room, and the nurse will teach you and your child how it works. PCA pumps are set up so that when your child wakes up after surgery, the button is ready to be used when pain is felt. Sometimes, an infusion (a little bit of medicine that runs constantly) is set up as well. When your child hurts, he should press the button. No one else should press the button. This is a safety issue; if a child is asleep, he has enough pain medicine in his system. Pressing the PCA button while the child is asleep is dangerous; it risks causing an overdose and severe harm to your child. If your child receives a PCA after surgery, do NOT push the button when your child is asleep.
Sometimes children and young adults develop long-term pain problems from accidents, surgery, chronic disease or for no obvious reason. We have a special clinic for children with chronic pain. It features a multidisciplinary team, which includes nurses, physicians, psychologists and physical therapists. If such a problem develops for your child, your doctor can consult the Pain Management Clinic to help care for your child after he leaves the hospital. If your child will be having an operation that requires him to be admitted to the hospital, ask your doctor how pain will be controlled and if the Acute Pain Service might be of benefit. We are not always needed, but we are always available and willing to help.
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