Pain following surgery is a worry for many people. Pain control is important for your recovery following surgery, we want you to be as stress and pain free as possible. The following methods can be used for your pain relief, depending on what suits you best. Morphine and codeine cause constipation; it is best to prevent this problem by drinking plenty, walking around, having a healthy diet, and taking laxatives.
Patient Controlled Analgesia (PCA)
This is a popular method, it allows you to be in control of your pain relief. Your PCA system will be set up in the recovery room when you wake up after surgery. At Heartlands we use electronic pumps with a handset. A drip will be set up and connected to a pump containing morphine. Whenever you feel pain, you press a button to receive a small dose of morphine from the pump.
You should press the button whenever you feel pain, use it as much as you need. Don’t wait for your pain to build up, it is harder to control again if this happens. It is useful to give yourself a dose before physiotherapy and getting out of bed.
The machine has a special safety feature – the machine switches off for five minutes after giving a dose of morphine. This prevents you getting an overdose, so you can press the button as much as you need.
You will normally have the PCA for 2 or 3 days after your operation. As the pain from your wound improves tablets should be able to control the pain.
Morphine infusion
For 24 hours after your operation this is a drip into a vein that continuously gives morphine from a pump. The dose is carefully calculated by your anaesthetist and the effect is monitored by your nurse.
Intrathecal morphine
This is a one off injection of morphine into the back, this is done in theatre. The injection is put into the fluid that surrounds the spinal cord. This stops the sensation of pain and may make you drowsy. The effect lasts for some hours and keeps you comfortable for the first night.
Are there any side effects?
Morphine can cause some side effects. Morphine causes constipation and you will need laxatives to help. Some people may feel sick – if you do, let your nurse know and they will give you anti sickness medication. Some people may have itching – antihistamine tablets and soothing cream can help. Some people feel a bit drowsy – this is quite normal, but if it is distressing please tell your nurse. If we think you are too drowsy we will reduce the dose of morphine, we can also give medication to block the effect of the morphine.
This is a one off injection of local anaesthetic between the ribs. The injection numbs the nerves on the side of the chest where your wounds are. The effect lasts for a few of hours. This is used if you do not have an epidural or paravertebral. It is usually done in theatre whilst you are still asleep, but it can also be done on the ward if required. This method does not usually have any side effects.
A thin flexible tube is inserted into your back whilst you are asleep in theatre. It sits between the ribs next to the nerves on the side of the chest, rather than by the spinal cord. Local anaesthetic can be given continuously. This numbs the nerves on the side of your chest where your wounds are. The paravertebral stays in place for up to 3 days. You do not need a catheter in the bladder with this method. This method does not usually have any side effects.
A thin, flexible tube is inserted into your back in theatre. This can be done either while you are still awake, or when you have already been put to sleep, depending on your anaesthetist. A local anaesthetic will be injected first to minimise any discomfort. The insertion takes about 20 minutes. The tip of the tube stays near the spinal cord (in the epidural space). Local anaesthetic and drug similar to morphine can be given through the tube continuously. This numbs the nerves on both sides of the chest, the stomach and legs. If you have an epidural you will also need a catheter in the bladder. The nurses will use cold spray to monitor how well the epidural is working. The monitoring is vital for safety reasons and to make sure the epidural is working. The epidural normally stays in for up to 3 days. After this time the nurses will remove the epidural and you can have another type of pain control.
- Paracetamol
- Ibuprofen
- Codeine or tramadol
If you need more pain relief you may have morphine instead of codeine/tramadol.
- Slow release morphine tablets – to be taken regularly
- Liquid morphine – to be taken as required
If you are struggling with constipation a glycerine suppository may be recommended to help open your bowels.