This brochure explains about pain relief after surgery. Today there are effective treatments available to help keep you comfortable after your operation. These will be explained to you before your operation and the most suitable one will be provided.

Why treat pain?

It was once thought that severe pain after surgery was just something to be endured. But we now know that this is no longer true. Today doctors and nurses can work with you before and after your operation to keep you comfortable. After major surgery, especially if in the chest or abdomen, it is very important to use a potent type of pain relief.

It is now known that good pain relief can offer many benefits

• Enjoy greater comfort while you recover from surgery
• Get better faster. With less pain you can walk sooner and do breathing exercises better.
• Better results after surgery. With good pain control, people having major surgery may be able to avoid problems like pneumonia, blood clots and stress on the heart

What is Pain?

Pain is the unpleasant feeling that you have after an injury or surgery. It may tell you that something is wrong with your body. But we know that enduring pain after a successful operation has no benefit and sometimes may only interfere with your recovery. Your doctors and nurses will ask you about your pain. In this way, they can help keep you comfortable or know if something may be wrong. It is important to say when you have pain

When part of your body is injured this stimulates special receptors on nerves. These send messages along the nerves to your spinal cord. In the spinal cord, these pain impulses travel along special pathways to the brain where they are processed to produce the feeling of pain. The experience of pain is personal - only you know how much pain you have or how much relief of pain you have had.

Pain control methods that you may use.

Today pain can be controlled by a variety of different ways - sometimes several of these are used together to get the best result. The best method for you and your operation will be discussed with you.

The effectiveness of your pain relief will be regularly assessed and if necessary it will be adjusted, added to or changed to make it the best and safest for you.

Some of methods involve giving different pain relieving drugs by various routes -

• Through a tube in a vein (an IV), an injection in your arm or leg, as a suppository, through a small tube in your back (an epidural) or by a tablet to swallow.

We now know that pain control using drugs is very safe - it is extremely unlikely to become addicted. The benefits of good pain control outweigh the small risks. To minimise the risks you will be regularly monitored and reviewed by staff with special training in pain control. They are available day and night to give you the best treatment possible.

Some special methods of pain relief.

A doctor, usually your Anaesthetist, will discuss with you the selection of pain relief. The two most common methods are called patient controlled analgesia (or PCA) and epidural analgesia. Analgesia is the medical word for pain relief.

Patient Controlled Analgesia (PCA)

This is where you control the amount of pain relief that you receive. This is done by using a special pump that contains the pain-relieving drug (often morphine) that is connected to you by a small tube. This small tube may connect to your IV or your epidural (see below). You control your pain relief by pushing a special button that makes the pump give you a small safe dose of pain relieving medicine. This will have an effect after a few minutes. It is important that only you are to press this button otherwise it may be dangerous. How often you push this button will determine how much pain relieving medication you receive. There is no right number of times to push the button - only you know how much effect you are receiving from the medication.

PCA is a safe way to give strong pain relieving drugs, however it is important that you know some of the unwanted effects that may occur from time to time. These strong pain-relieving drugs act in the brain where they produce other effects. You will normally feel mild sleepiness, if this is excessive you will be treated for it. It is not uncommon to have some nausea or vomiting after having an operation and there are many reasons for this including some pain relieving medicines. If you have nausea or vomit then tell the nurses or doctors and an injection of an anti-nausea drug will be given. If nausea is an ongoing problem then further changes can be made to treat it. Sometimes people may feel itchy when getting pain treatment. Often this is only mild, however it can be treated with anti-itching medication a change to a different pain relieving medicine can be made.

Epidural analgesia

This is probably the most effective method of pain relief available after surgery. It is given by using a very small tube that is placed in your back near your spinal cord. This tube is then used to give pain-relieving medicines that act on nerves and block pain impulses from reaching your brain. The benefits of this method over others are the effective pain relief that it produces and the lessening of unwanted effects such as drowsiness and nausea. When used after major surgery it offers the greatest possible benefit of aiding a pain free recovery and avoiding some unwanted problems from surgery.

As epidural analgesia is an elaborate method of pain relief, it will be frequently and closely supervised by specially trained staff to ensure it is working effectively and safely. This achieves good results.

Some other common effects may happen with epidural analgesia. Some people may get a feeling of slight numbness or heaviness in their legs. This can occur when epidural analgesia is used to treat pain after surgery on the lower part of the abdomen or legs. If excessive or troublesome then it will be treated.

Some extremely rare problems can occur to people having epidural analgesia. Some of these you should know about. The epidural catheter (the tiny tube in your back) may become infected. You may then notice pain and tenderness in your back at the spot where the epidural is inserted. Another very rare problem is excessive bleeding occurring near to the epidural catheter in your back that could, if not treated, cause pressure and damage to your spinal cord. In both cases, prompt treatment will prevent any permanent damage occurring

The Acute Pain Service

At Westmead Hospital, we are interested in providing the best and safest pain relief for all patients after surgery. To ensure this we have an Acute Pain Service that consists of doctors and nurses who provide specialised pain treatment to any patients who require it. Ask your nurse or doctor if you wish to contact the Acute Pain Service.