What is the Acute Pain Service?
Of the 30,000 procedures done every year at Cincinnati Children's Hospital Medical Center, the primary physician or surgeon can usually take care of the discomfort from the procedure. However, a number of surgeries and procedures require expert care for the pain that comes with those procedures.
The Acute Pain Service cares for many patients per year who have undergone surgical operations or who have come to the hospital with illnesses that are painful. The Pain Service is a group who specializes in taking care of pain in infants, children and young adults. Our goal is to keep the children safe and comfortable. We have a variety of safety protocols in place.
It is important to know, that we design a pain treatment plan to fit into the overall care plan that the surgeon or pediatrician has for your child. Though completely eliminating pain (after surgery) would be ideal, it is frequently not a desirable goal because of the side effects of the pain medications and these complications can very much interfere with the recovery process. 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 extent possible.
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.
Back to Top
Before the operation
A physician from the Pain Service will usually visit your child before surgery to discuss with you the options for keeping him or her comfortable afterwards. Some of the treatments you may hear about include:
- Patient Controlled Analgesia, (PCA or "pain pump" or "pain button")
- Epidural or caudal
- Peripheral nerve blocks.
Other treatments include a variety of 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 with you the options that are reasonable for your child and his or her medical situation. Then 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 to see your child while hospitalized.
Back to Top
During the operation
An epidural catheter is one that is placed in a space between the bones of the spine and the spinal cord to continuously instill pain medications. Many people know this treatment best as one 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. Epidurals are most often placed while the child is asleep. That way, the child is not scared, does not feel it and does not move (which could cause problems).
The epidural medication is started in the operating room. This may allow the anesthesiologist to use less anesthesia, which may allow 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 1 to 5 days, depending on the surgical care plan.
Back to Top
After the operation
We will visit your child every day to make sure pain is safely and effectively controlled, and to answer any questions you have about pain and its treatment. A member of the Pain Service is available by phone to take care of problems 24 hours a day, seven days a week. Your nurse will know how to reach the Pain Service, in case there is a question or concern about your child's pain 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.
PCA pumps are set up so that when your child wakes up after surgery, the button is right there, 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 or she should press the button. No one else should press the button. This is a safety issue; if a child is asleep, then they have enough pain medicine in their system. Pressing the PCA button while the child is asleep is dangerous as it risks causing an overdose and possibly severe harm to the child. So if your child receives a PCA after surgery, please do NOT push the button when your child is asleep.
For children with painful medical problems, a PCA pump can be set up in your child’s room, and the nurse will teach you and your child how it works. Sometimes children and young adults develop long-term pain problems from accidents, surgery, chronic disease or sometimes 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 they go home.
If your child will be having an operation that requires him or her to be admitted to the hospital afterwards, 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.
Back to Top
