Pain | Anesthésistes de la Polyclinique du Parc de Cholet (49)

Pain is not inevitable. You are going to have surgery and you may fear that after the operation you will be in pain. This apprehension is quite normal. The anaesthetists and the specialized nurses who will be caring for you can offer efficient techniques and treatments to deal with postoperative pain and discomfort.

During your consultation, the anaesthetist will explain the strategy for your anaesthesia and pain relief. Please feel free to ask any questions that come to mind.

The principal medications used are paracetamol, anti-inflammatory drugs, morphine (or its derivatives) and local anaesthetics (by epidural or by the surrounding nerves). In order for it to be active as soon as you come round, this medication will be injected during your anaesthetic. A technique which includes your participation may be used. This is called PCA or Patient Controlled Analgesia. This can be used on its own or in association with other medication.

Pain evaluation

Whatever technique is offered, the nurse will make regular evaluations of your pain in order to make sure that you are given sufficient pain releif. Be sure to tell the nurse of any discomfort you feel (drowsiness, nausea, stomach pain, itchiness, paralysis or stiffness in one of your arms or legs…)

The nurse will ask you regularly if you are feeling any pain.
You can reply:

either by saying how intense the pain is: slight, moderate, great, very great, unbearable;
or by quantifying the pain on a scale of 1 to 10, 1 being the absence of any pain and 10 being the greatest pain you can imagine ;
or by quantifying the pain using a slide rule that you can adjust between the two extremes (absence of pain up to intolerable pain).

Frequently asked questions:

If I am given morphine, will I become dependent?
Is the use of morphine an exceptional measure?
What are the disadvantages and risks associated with morphine ?
What is PCA (Patient Controlled Analgesia)?
What is epidural analgesia?
What are the alternatives to epidural analgesia ?
If I am offered intravenous or epidural PCA, is it possible to press too often on the button?
How do I know if it is working properly?

If I am given morphine, will I become dependent?

No, the risk of becoming dependent because you have been given morphine or morphine-based drugs for post-operative pain is nil.

Is the use of morphine an exceptional measure?

No, morphine and morphine-based drugs are used on a daily basis to relieve post-operative pain.

What are the disadvantages and risks associated with morphine ?

Morphine provides effective pain relief but if its sedative effect is too great, doses may have to be reduced. It can cause nausea, vomiting, constipation, itchiness, hallucinations, difficulty in urinating or a reduction in the respiration rate. Patients will be checked for all these side effects. If they occur, they will be monitored and can be treated by the anaesthesia team.

What is PCA (Patient Controlled Analgesia)?

Your PCA will be programmed specially for you by your anaesthetist to relieve your pain and to provide maximum comfort. The equipment has a syringe containing the analgesic and an electronic pump that you will activate by pressing on a button. You will relieve your pain by administering your dose of analgesic. The medication can be injected directly into a vein (intravenous PCA) or around the spinal cord by epidural (PCEA). Your safety is ensured by a dosage control mechanism.

What is epidural analgesia?

Epidural analgesia is at present the best available method to relieve pain after major abdominal surgery. It blocks the transmission of painful sensations coming from the site of the surgery by the injection of a local anaesthetic and/or morphine around the nerves.

Using a special needle, an ultra fine tube (epidural catheter) is put in place in the lower back, leading into the epidural cavity around the spinal cord. The catheter will remain in place for the first few days after surgery to allow continued administration of the analgesic.

What are the alternatives to epidural analgesia ?

In the case of contraindication or refusal by the patient, other methods of analgesia can be offered using intravenous injection with PCA.

If I am offered intravenous or epidural PCA, is it possible to press too often on the button?

No, anaesthetist sets the pump to a secure dose and your pain relief will be safely ensured. But you must be the only one to press on the button.

How do I know if it is working properly?

PCA has a maximum security level and an alarm that immediately alerts a nurse if there is a problem. PCA is a very effective method of pain relief in that the patient is no longer constantly dependent on the nursing staff. It is a great improvement on previous methods.