• Reference Number: HEY-383/2018
• Departments: Pain Medicine
• Last Updated: 30 September 2018

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Not all types of pain relief medication are suitable for all patients or appropriate for all conditions / types of surgery.  The doctor / anaesthetist will discuss the type of pain relief medication that will be suitable for you.

Oral Pain Relief Medication

Oral pain relief medication (taken via the mouth) alone is often enough to help relieve your pain.  If you are able to tolerate fluids you will be given oral pain relief medication. It may also be used to supplement other forms of pain relief medication after larger operations.

Tablets will be prescribed regularly (the doctor will write a prescription for your tablets to be given at regular intervals during the day) throughout your stay in hospital. The nursing team will offer these to you when they do their regular ‘drug rounds’.  If you are in pain at other times please ask for extra tablets, as it is easier to control your pain by simple methods before it becomes uncomfortable.  For example, it is advisable to ask your nurse for pain relief medication to make you more comfortable so that you are able to move around during the day and help you have a comfortable night. This will help you to get a better night’s sleep.

If you are not able to eat and drink but have a feeding tube into your nose or stomach, then it may be possible to administer your drugs in this way.

Intravenous Patient Controlled Analgesia (IV-PCA)

This is a method of pain relief medication known as Intravenous Patient Controlled Analgesia (IV-PCA) used mainly after major surgery.

If you are about to have a major operation, the anaesthetist may suggest that you have an Intravenous Patient Controlled Analgesia (IV-PCA) pump afterwards.  This is a device that allows you to give yourself pain relieving medication when you need it.  It consists of a pump that is filled with pain relieving drugs and is connected to the drip in your arm or neck.  When you press the button on the handset a small dose of the drug will be delivered directly into your drip. This takes about 5 minutes to work and during this period the pump will not deliver another dose even if you press the button.  This is so you have time to feel the benefit of one dose of the pain relieving medication before getting another dose.

Occasionally non-surgical patients experiencing severe acute pain will benefit from IV-PCA.

An IV-PCA pump has the great advantage that you are in control of your pain relief medication.  Further information is available on a separate information leaflet (Intravenous Patient Controlled Analgesia). Please ask for details.

Patient Controlled Epidural Analgesia (PCEA)

Patient Controlled Epidural Analgesia (PCEA) is an effective form of pain relief medication usually used after certain types of major surgery.

The nerves from your spine to your lower body pass through an area in your back close to your spinal cord, called the ‘epidural space’.

An epidural is done by injecting local anaesthetic through a long thin plastic tube called an epidural catheter, into the epidural space.  As a result the nerve messages are blocked.  This may cause numbness, which varies in extent according to the amount of local anaesthetic injected.  If you experience numbness, full feeling should return when the epidural is reduced or stopped.

An epidural pump allows local anaesthetic to be given continuously and the amount of drugs given is carefully controlled.  Other pain relieving medication such as paracetamol can also be given.

You may be able to press a button on a handset to give a small extra dose from the pump. Your anaesthetist will set the pump to limit the dose you receive, so overdose is extremely rare. If you do overdose, the PCEA will be stopped and drugs will be given to stop the unwanted effects of the epidural.

PCEA provides better pain relief than most other methods, particularly when you move.  PCEA reduces the risk of complications after major surgery such as nausea/vomiting, leg/lung blood clots, chest infection and delayed bowel function.  You should experience a quicker return to eating, drinking and full movement, possibly with a shorter stay in hospital compared to other methods of pain relief.

Further information is available on a separate information leaflet (Patient Controlled Epidural Analgesia).  Please ask for details.

Intrathecal Analgesia

Sometimes your Anaesthetist will decide to use an intrathecal injection.  This is strong pain relieving medication that is injected into your spine, either before your operation or once you are asleep.

This type of pain relief medication will last for about 12 – 24 hours and once it starts to wear off, the initial post-operative pain should have settled.

There are quite a few side effects with this type of analgesia

The side effects include:

• Nausea
• Extreme itchiness (Pruritus)
• Leg weakness
• Tired / sleepiness
• Feeling dizzy or light headed
• Respiratory depression (your breathing will get slower and you may stop breathing), this is a serious but uncommon side effect.

If you have this injection, depending on the dose you were given, you may need to spend 24 hours in a high observation are (HOB) or in intensive care (ICU).  This is to ensure you are closely monitored for any serious complication.

Transdermal Patches

If you are not able to eat and drink, and have no feeding tubes and this is expected to be for a number of days or weeks, you may be prescribed a pain relief medication patch. These are usually applied to the tops of your arms and would be changed every 3 – 7 days.  If you have a raised temperature they would not be used as you will absorb too much of the drug through your skin.  Once you are able to eat and drink, you will be started on oral analgesia.  You would not normally be discharged with patches if you can eat and drink.

Local Anaesthetic Infusion Devices

Your doctors may decide that a local anaesthetic infusion device may benefit you.  This is a small plastic tube that is placed in your operation site and steadily releases local anaesthetic into the wound, for up to 3 days.  The operation site should not feel as uncomfortable.  Once the drug is infused, the tube is removed from your wound.  Sometimes these devices can make your wound will leak more but it will just need a new dressing.  There are times when it may be necessary to remove them.  There is a regulator that needs to be fastened to your skin (with a dressing) to ensure the pumps work correctly.

What happens afterwards?

When you leave the hospital you may be given pain relief medication to take home.  Follow the printed instructions on the box / bottle of medication.  These medicines are usually labelled “take when required for pain relief”.

When you go home, you may need to take them regularly for the first day or two.  As you recover you will be able to reduce the amount you take each day.

If you are unable to manage your pain you should contact your own doctor (GP) for advice.  You should not need to continue on the strong pain relief given to you from the hospital.  Mild pain can be managed with simple pain relief medication, e.g. paracetamol. However, some people do need to take regular strong pain relief medication. If this applies to you, this will be explained to you by the nurse when your take home prescription is given to you.

Some pain relief medication can cause constipation.  If this is a problem, laxatives can be bought at your local pharmacy/chemist or prescribed by your GP.

Please read the information leaflet.  Share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following your hospital stay.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Pain Management Nurse Team via the hospital switchboard. Telephone No: (01482) 875875 (Monday -Friday)

If they are not available contact the Anaesthetic Department, Hull Royal Infirmary Telephone No: (01482) 674542

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and well-being and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.