POST OPERATIVELY – FIRST STAGE RECOVERY
A well working regional technique should provide ideal conditions for a child in recovery; pain-free, alert, free from nausea and vomiting
If there are doubts regarding analgesia, consider giving a small dose of a fast-acting opiate e.g., 0.25mcg/kg of fentanyl or 0.2-0.3mg/kg of ketamine. If the block is effective, the child will immediately settle.
If doubts remain regarding the efficacy of your block, it may be prudent (operation dependent) to consider additional analgesia e.g., systemic opiates in the form of an NCA or PCA-pump (nurse-controlled or patient-controlled analgesia)
All patients should be written up for regular simple analgesia such as regular paracetamol and/or ibuprofen (as appropriate) and alternative systemic analgesics should be prescribed as rescue analgesia. When the block wears off, these will reduce the risk of ‘rebound pain’.
Post-operative monitoring of the block is imperative (by the ward nurses and by the acute pain team) to identify any issues early, including:
- Local anaesthetic toxicity (e.g., with continuous LA infusions)
- Infection of the block site
- Compartment syndrome (See ESRA/ASRA guidance 2015)
NOTE: It can be difficult to distinguish pain from emergence delirium or in fact just the displeasure of being in the theatre environment, the “pins and needles” sensation or the presence of dressings/cast. The help of an experienced recovery nurse and parent aids diagnosis.
