It is a tough sell but patients undergoing surgery for any reason must take their pain medications as prescribed. That means the full amount as often as recommended. Many Americans still subscribe to the belief that if there’s “no pain, there’s no gain”. And they feel it is better to “tough it out” rather than take drugs.
But the truth is — research shows that uncontrolled pain turns on systems in the body that result in delayed or impaired healing. In addition, there are more complications in general, breathing problems, and the risk of death is much higher.
All of these concepts also apply to children. In the pediatric post-operative group, pain increases the child’s stress. Stress hormones increase tissue metabolism and that leads to negative effects on healing. The result is besides pain, the child ends up with a longer hospital stay, which adds more stress and keeps the cycle of impaired healing going.
What can be done to prevent the impact pain can have on a child after surgery? In this article, surgeons answer this question as it relates specifically to orthopedic surgery. They tell us that most surgical teams and postoperative hospital staff take the task of pain control among children very seriously. They may even have a team dedicated to this job.
The first step is family and patient education. Everyone involved with the child’s case must understand the importance of pain control and the consequences of inadequate pain management. The surgeon, anesthesiologist, and nursing staff help parents, family members, and care givers of children understand how the pediatric body responds to pain.
From the youngest baby to the oldest child, decisions about medications for pain control are based on several individual factors. Body weight is important because the water content affects how drugs bind with proteins in the blood. Age and size determine the water-to- protein ratio and thus the amount of drug to use (e.g., anesthesia during surgery, narcotics for pain control after surgery).
There are strict guidelines for the use of pain relievers. One important factor that affects the selection of medications is the child’s health. For example, the presence of any other health conditions (e.g., asthma, diabetes, allergies, bleeding disorders) must be considered carefully. The type of orthopedic surgery, extent of the surgery, and length of the procedure (in time) can also make a difference in postoperative selection of pain medications.
The anesthesiologist can choose from a wide variety of drugs for the actual procedure including nonopioid (nonnarcotic) pain relievers, opioid analgesics (narcotic pain relievers), local anesthetic injection, regional analgesia, epidural therapy, and peripheral nerve blocks. Likewise, the surgeon has quite a few choices for pain control after the surgery.
The authors of this article provide surgeons and physicians with detailed information in the use of these many drug categories. Drug type, drug dose (amount of drug given), and drug administration (by mouth, by injection, or intravenous directly to the bloodstream) are discussed in detail. Adverse effects of each drug are also presented. Several helpful tables are provided with guidelines for the use of each type of drug.
Finally and equally important to the details of the drugs given are the specific individual characteristics of each child. It’s clear that pain is different from one child to another even when they have the same surgery for the same problem. That’s why each child is evaluated and monitored separately from all other children. It’s not a one-protocol-fits-all kind of situation.
Pain control and drug usage is serious business and must be approached that way in each and every case. This review article goes a long way in providing a useful review of evidence-based guidelines for pain control during and after orthopedic surgery for children of all ages.