Event 3: Courtney's Post-Surgical Experience

Pain Experience

Courtney answers how much pain she experienced after her surgery.

Explaining Pain Assessment

Discuss Expectations for Surgery and Recovery

• Address both patient and family expectations (may be different)
• Goals for pain management at different time points e.g. immediate post-op, at discharge, week 1 at home
• Communication preferences after discharge e.g. phone, text

Review Pain Assessment Tools to be Used and Preference

• Adolescent Pediatric Pain Tool- includes body outline drawing, pain characteristics and NRS
• VAS or NRS- word anchors versus numbers or both
• Functional assessment
• Discuss frequency of assessment

Discuss Pain Medication Delivery

• PCA-Patient Controlled analgesia
• Nurse administered medications
• When to ask for pain medication
• How to use pain medication at home

Principles of Pediatric Pain Assessment

Patient and parents are the experts in reporting pain.

A comprehensive pain assessment includes:

• Intensity
• Location
• Quality, character
• Alleviating and aggravating factors
• Onset
• Duration
• Variations and patterns
• Current treatments and their effectiveness

How Was Your Pain and How Was it Managed?

Courtney tells more about her pain and how it was managed.

Pain Assessment Goals

• Recognize and respond to adolescent’s pain with mutual understanding of goals
• Help inform your treatment decisions in consultation with patient/family
• Determine the effectiveness of treatment and the need for additional intervention
• Provide a record of pain experience and  interventions

Do You Remember Which Medications You Received for Pain?

Courtney answers whether she remembers which medications she received for pain.

Analgesic-Related Adverse Effects of Opioids

Gastrointestinal

• Ileus
• Nausea/vomiting
• Constipation
• Abdominal Pain

Respiratory

• Hypoventilation
• Oxygen desaturation

Central Nervous System

• Sedation
• Dysphoria 

Cutaneous

• Pruritus

Treatment for Opioid Side Effects

Gastrointestinal

• Nausea/vomiting – use of anti-emetics
  • Examples: ondansetron, prochlorperazine, trimethobenzamide
• Constipation – Start stool softener and motility agents before surgery
• Ileus
  • Early mobilization
  • Early feeding
  • Occurs less often with epidural analgesia
• Respiratory
  • Oxygen saturation monitoring
• Pruritus
  • Anti-allergy medication
    • Example: Benadryl

What Helped With the Pain Besides Medication?

Non Pharmacological Treatment

Non Pharmacological approaches are an important part of postoperative pain care.

These include:

• Distraction – music, videos
• Guided Imagery/meditation
• Breathing relaxation techniques
• Application of heat/cold
• Positioning for comfort