Paediatrics: Post-operative care: analgesia

Post-operative care: analgesia

Analgesia for day cases

Operations are painful and analgesia is essential.

•   In many cases, local anaesthetic blocks or wound infiltration will provide complete analgesia for several hours.

•   After this simple analgesics, such as paracetamol or ibuprofen are usually all that is required.

•   For older children codeine and/or diclofenac may be necessary. A prescription for 2–3 days should be given prior to discharge.

Analgesia for major surgery

After major surgery stronger analgesia is required for a longer period. This applies to neonates, as well as older children.

Continuous epidural infusions of local anaesthetics

There are many advantages to local or regional analgesia and continuous epidural infusions of local anaesthetics (e.g. bupivicaine) work particularly well after major abdominal or thoracic surgery.

•   Epidural infusions are not without risk. It is essential that close nursing supervision is maintained (i.e. vital signs and level of the epidural block).

•   In many hospitals there is a ‘paediatric pain team’ who supervise the epidural. If this is not available, close liaison should be maintained with the anaesthetist responsible.

•   If the level of anaesthesia seems to be rising to the upper thoracic dermatomes the infusion should be stopped pending advice.

•   If the analgesia is inadequate advice should be sought before either removing the epidural catheter or starting opiates.

Continuous IV infusion of morphine

Infusion of morphine or other opiates is another very effective method of post-operative analgesia. For older children, this may be in the form of a patient-controlled analgesia pump with a button the child can press to obtain an increment of analgesic.

•   Most hospitals will have guidelines on the use of analgesics for children that should be followed. ‘Pain ladders’ providing options for analgesics of increasing potency are becoming common.

It is not acceptable to leave a child in pain and it is simply untrue that administering strong analgesics will mask clinical signs. Peritonitis can be detected reliably in a child who has received morphine.