• Reference Number: HEY383/2025
• Departments: Pain Medicine
• Last Updated: 30 April 2025

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 who has been caring for you.

After your surgery, the nurses will frequently assess your pain to ensure you are comfortable and safe. Good pain management is essential for your recovery and progression for discharge, ensuring you can deep breathe and cough (reducing the risk of chest infections), encouraging mobility and independence and shortening your hospital stay. Not all types of pain relief are suitable for all patients or appropriate for all conditions/types of surgery. The doctor/anaesthetist will discuss the type of pain relief that will be best for you when he/she visits you.

Oral Pain Relief Medication

Oral pain relief (taken by mouth) is usually the preferred method of pain relief after your operation if you are tolerating oral fluids. This is because they are usually better tolerated, have less risk of side effects, and give a more consistent level of pain relief. Oral pain relief will usually be prescribed at regular intervals after your surgery, but please do not hesitate to inform your nurse if you are in pain and are requiring additional pain relief between these doses. If you have ever had any unacceptable side effects or intolerances to any pain relief, please inform your nurse or doctor.

Intravenous Patient Controlled Analgesia (IV-PCA)

If you’re having a major operation, the anaesthetist may suggest that you require an intravenous patient-controlled analgesia (IVPCA). This is a device that is connected as a drip to a cannula that allows you to give yourself a dose of strong pain relief (usually morphine), by pressing a button on a handset. This medication will work quickly so you can press this when you are in pain and before you need to cough or move, if it is uncomfortable to do so. After you press the handset, the device will “lock out” for 5 minutes to keep you safe. You can also have oral pain relief alongside the IVPCA if you are able to tolerate oral fluids. The Acute Pain team will review you after your surgery to offer support and advice, but if you have any questions, please do not hesitate to ask your nurse.

Epidural

If you’re having a major operation, the anaesthetist may offer you an epidural to help manage your pain after surgery. An epidural is a small tube (catheter) inserted into your spine, which will administer medication (local anaesthetic) as a continuous infusion, and you may have a handset you can press if you need a small extra dose of pain relief. If the anaesthetist thinks you may benefit from an epidural, they will explain the procedure and explain the risks and benefits of having an epidural. An epidural can stay in your back for a maximum of 5 days and can be a very effective method of pain relief and should enable you to recover and mobilise much quicker after surgery. If you are prescribed blood thinners (anti-coagulants) for example apixaban or warfarin, or anti platelet medications i.e. clopidogrel, please let the anaesthetist know.

Local anaesthetic infusion devices

Your doctors may decide that a local anaesthetic infusion device may benefit you.  This is a small plastic tube (catheter) that is placed in your operation site and steadily releases local anaesthetic into the wound, usually for up to 3 days. The operation site should not feel as uncomfortable, but you may have more tape around the surgical site to secure the tube to your skin. Once the drug is infused, the tube is removed from your wound and is disposed of.  Sometimes the local anesthetic can leak around your wound, but this usually requires a simple change of dressing.

Intrathecal (Spinal) Anaesthesia

Sometimes your Anaesthetist will decide to use an intrathecal injection as a method of pain relief for your operation.  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 to 24 hours and once it starts to wear off, the initial post-operative pain should have settled.

There is a small chance you may experience some side effects; however, most are easily managed. These side effects can include:

• Nausea
• Extreme itchiness (Pruritus)
• Leg weakness
• Tired / sleepiness
• Feeling dizzy or lightheaded
• 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 area (HOB) or in intensive care (ICU).  This is to ensure you are closely monitored following your operation.

Side Effects

It is important that you inform your nurse if are experiencing any side effects from your pain relief. Many common side effects are easily treatable so you can continue taking your required pain relief after surgery.

• Constipation – opioids including codeine and morphine may cause constipation, please inform your nurse if you are struggling to open your bowels because you may require laxatives
• Nausea/ vomiting – opioids can cause nausea (feeling sick). This can be treated with anti-sickness medications (anti-emetics)
• Itching – opioids may cause you to feel itchy. If this is intolerable or bothering you, you may be given an antihistamine

If the pain relief medication makes you feel drowsy, sleepy, dizzy or other general intolerance, please inform your nurse/ doctor as you can be given an alternative pain relief medication/modality.

Recovery and discharge

The nurses on the ward will frequently assess your pain during your hospital stay. As you are recovering after surgery, you should require less pain relief day by day. Your pain relief will be frequently reviewed whilst you are in hospital.  If you are taking strong morphine tablets, this may be stepped down to a weaker pain relief when your pain improves.  If you are still requiring pain relief when you are discharged from hospital, the doctor/ nurse will explain what you are taking, when to take it and how to reduce your pain relief. If you continue to require pain relief after your tablets have finished, you will need to contact your own doctor (GP) for advice.

Should you require further advice on the issues contained in this leaflet, please speak to your medical and nursing team, who can refer to the acute pain service if required.