Acute Pain Service

Being as fit and well as possible before surgery can help you recover and may reduce the chance of problems afterwards. It can also help with pain control.

Our colleagues in Surgery School can help you prepare for your operation and recovery. Their advice is suitable for people with different levels of fitness and mobility.

Small changes before surgery can make a real difference to your recovery.

Surgery School covers:

• Preparing for your operation
• Eating well and drinking enough
• Activity and lifestyle advice
• The iCOUGH programme, which helps you look after your lungs
• What to expect after surgery

For more information, visit the Portsmouth Surgery School page. 

Some pain or discomfort after surgery is normal. Good pain relief is an important part of your recovery.
Good pain relief can help you:

• Move around more easily
• Take deep breaths and cough more comfortably
• Reduce the risk of chest infections
• Lower the risk of blood clots
• Sleep better
• Take part in physiotherapy and recovery exercises
• Reduce the chance of long-term pain after surgery

The aim is not always to remove all pain. We aim to keep your pain controlled enough for you to rest, sleep, breathe deeply, cough and move safely.

Tell your healthcare team when pain is starting to become uncomfortable. Pain is often easier to control when it is treated early. Also tell us if pain is stopping you from taking a deep breath, coughing, sleeping or moving.

Paracetamol

Paracetamol is often used for mild to moderate pain after surgery.

Anti-inflammatory painkillers

Medicines such as ibuprofen can reduce pain and swelling. These medicines are sometimes called NSAIDs. They are not suitable for everyone.

Opioid painkillers

Opioids are stronger painkillers. Examples include morphine, oxycodone, tramadol and fentanyl. They may be used after major surgery or when stronger pain relief is needed. They are usually used for a short time and staff will monitor you while you need them.

PCA pain relief pump

A patient controlled analgesia (PCA) pump lets you give yourself small doses of pain medicine through your drip when you need it. The pump has safety limits. Read the PCA section for more information.

Epidurals and nerve blocks

An epidural or nerve block can numb part of the body and provide strong pain relief during and after surgery. These treatments can reduce the amount of opioid pain medicine you need. Read the Epidurals and Nerve Blocks section for more information.

Wound catheters

For some operations, local anaesthetic can be given through a small tube near the wound. Local anaesthetic is medicine that numbs an area of the body.

Your anaesthetist may discuss an epidural or nerve block with you to help control pain during and after surgery. These treatments may also be used after some injuries, such as rib fractures.

They can give very good pain relief, reduce the need for strong opioid painkillers and help you recover.

What is an epidural?

An epidural uses a very thin, flexible tube called a catheter. The tube is placed in your back. Pain-relieving medicine can then be given through the tube during and after surgery.

Possible benefits of an epidural

• Very good pain relief
• Less need for opioid painkillers
• Easier deep breathing and coughing
• More comfort when moving
• May reduce some problems after surgery
• Can help you get up and move sooner

An epidural is not suitable for every patient or every operation. Your anaesthetist will discuss whether it is a suitable option for you.

Possible side effects and risks of an epidural

Possible side effects include:

• Low blood pressure
• Difficulty passing urine
• Itching
• Feeling sick
• Headache

Rarely, an epidural can cause nerve damage. Your anaesthetist will explain the risks that are most important for you.

For more information, visit the Royal College of Anaesthetists – Epidural anaesthesia during and after surgery page. 

What is a nerve block?

A nerve block is an injection of local anaesthetic around a nerve or group of nerves. It temporarily numbs part of your body.

A nerve block can be used on its own or with a general anaesthetic. It can give pain relief during surgery and for many hours afterwards.

Possible benefits of a nerve block

• Very good pain relief
• Less need for opioid painkillers
• Less sickness and drowsiness
• Getting up and moving sooner
• Faster recovery
• In some cases, surgery can be carried out without a general anaesthetic

What will the numb area feel like?

The affected area may feel warm, numb, heavy or tingly. It may also be weak for a while. This is expected and should gradually wear off.

Follow the advice from your healthcare team about protecting and using the numb part of your body until normal feeling and movement return.

Possible risks of a nerve block

Most nerve blocks work well. Sometimes a block may not give enough pain relief or may last for a shorter or longer time than expected. Rarely, nerve damage can happen. Your anaesthetist will explain the risks that are most important for you.

For more information, please visit the Royal College of Anaesthetists – Peripheral nerve blocks page. 

Shared decision-making

If an epidural or nerve block is recommended, your anaesthetist will explain the benefits, possible risks and other options. They will also listen to your questions and preferences. Together, you can decide what is right for you.

For more information, visit the Royal College of Anaesthetists – Anaesthesia explained video.

After some operations, your healthcare team may recommend a patient controlled analgesia (PCA) pump.

A PCA lets you give yourself small doses of pain medicine through your drip when you need it. The medicines most often used are morphine or fentanyl.

How does a PCA work?

When you feel pain, you press the PCA button. The pump gives a set dose of medicine through your drip. Built-in safety limits stop doses being given too close together.

Staff will regularly check your pain, breathing, oxygen level and how awake you are while you are using the PCA.

Benefits of a PCA

• Fast-acting pain relief
• Lets you manage pain when you need to
• Avoids delays waiting for a dose of medicine
• Adjusts pain relief to your needs
• Supports movement and recovery
• Allows staff to monitor your treatment closely

What can I expect?

Your pain may not disappear completely. The aim is to keep you comfortable enough to:

• Rest
• Sleep
• Breathe deeply
• Cough effectively
• Move safely
• Take part in your recovery

Possible side effects

Common side effects include:

• Feeling sick or being sick
• Drowsiness
• Itching
• Dizziness
• Constipation

Serious problems are uncommon. The pump has safety limits, and staff will check you regularly while you are using it.

Some patients still need pain medicine after leaving hospital. Before you go home, your healthcare team will explain:

• Which medicines to take
• How much to take and how often
• How to reduce them safely
• How long you are likely to need them
• Side effects to look out for

You will be given a discharge plan explaining your pain medicines and how long you are expected to need them.

Opioid painkillers

Some patients are prescribed opioid painkillers for short-term pain after surgery. Examples include:

• Oral morphine
• Oxycodone
• Tramadol
• Codeine
• Dihydrocodeine
• Tapentadol

Opioids can be very effective, but they are usually intended for short-term use after surgery.

Using opioids safely

• Take them exactly as prescribed
• Do not take extra doses
• Do not increase the dose yourself
• Avoid alcohol while you are taking them
• Do not share your medicines with anyone else
• Tell your doctor or pharmacist about any other medicines you take

Dependence and addiction

When opioids are used for a short period after surgery and taken as prescribed, the risk of addiction is low. Your body can still get used to opioid medicines if you take them for some time. This is called physical dependence, and it is different from addiction.

Follow the plan you are given for reducing and stopping your opioid medicine. If you find that you cannot reduce it as planned, ask a healthcare professional for advice.

Driving

Do not drive if your medicine makes you:

• Sleepy
• Dizzy
• Confused
• Unable to concentrate
• Otherwise unsafe to drive

Some opioid medicines are covered by UK drug-driving law. Take your medicine as prescribed and do not drive if it affects your ability to drive safely. If you are unsure, ask a doctor, pharmacist or other healthcare professional.

For more information, visit the GOV.UK website. 

Safe storage and disposal

• Keep medicines in their original packaging
• Store them securely and out of reach of children
• Return unused opioid medicines to your local pharmacy
• Never share prescribed medicines

Ask for medical advice if:

• Your pain is getting worse instead of improving
• Your medicines are not controlling your pain
• You develop new symptoms
• You are unable to reduce your opioid medicine as planned
• You have severe or worrying side effects

Where to get advice

Use the contact details you were given when you left hospital. Depending on your situation, you can also contact:

• Your surgical ward
• The service named on your discharge information
• Your GP
• NHS 111

Not everyone needs a specialist Acute Pain Service review. Your anaesthetist will decide whether you need to be seen by the Acute Pain Service. If specialist review is needed, this will be arranged within the hospital.

Not always. Some discomfort is expected after most operations. The aim is to keep your pain controlled enough for you to rest, sleep, breathe deeply, cough and move safely.

Tell your healthcare team when pain starts to become uncomfortable. Pain is often easier to control when it is treated early. Also tell staff if pain is stopping you from taking a deep breath, coughing, sleeping or moving.

Tell your healthcare team which medicines you already take and about any problems you have had with pain relief before. They will take this into account when planning your pain relief.

Only you should press your PCA button. A relative, friend or member of staff should not press it for you.

The numbness, heaviness or tingling should gradually wear off and normal feeling and movement should return. Your pain relief plan may include other medicines. Tell staff if your pain is not controlled.

When opioid painkillers are used for a short period after surgery and taken as prescribed, the risk of addiction is low. Your body can still become physically dependent on them if they are taken for some time. This is different from addiction. Take them exactly as prescribed and follow the plan you are given for reducing and stopping them.

Do not drive if the medicine makes you sleepy, dizzy, confused, unable to concentrate or otherwise unsafe to drive. Take the medicine as prescribed. If you are unsure whether you should drive, ask a healthcare professional.

If your pain is not improving, is getting worse, or you are worried about your recovery, use the contact details on your discharge information. You can also contact your GP or NHS 111.

Ask your anaesthetist or healthcare team. They can explain why a treatment is being suggested, its benefits and risks, other options, and what may be most suitable for you. Your preferences should be part of the decision.