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


  • Ileus
  • Nausea/vomiting
  • Constipation
  • Abdominal Pain


  • Hypoventilation
  • Oxygen desaturation

Central Nervous System

  • Sedation
  • Dysphoria 


  • Pruritus

Treatment for Opioid Side Effects


  • 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
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