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Pain control and analgesia


Pain control – forward planning

Many interventional radiology procedures do not require any analgesia; some procedures are intrinsically painful, especially if they are prolonged, and others are unpredictably uncomfortable. The procedure will be simpler and the patient less distressed if pain can be kept to a minimum; they will be even happier if pain can be avoided altogether. Preventing severe pain is likely to increase everyone's confidence in you! Remember pain and anxiety affect the patient pre-, peri- and post-procedure to a varying degree, so there is no ‘one size fits all’ solution. As always, forward planning is the key to success; recognize which procedures and which particular stages are likely to require analgesia.

If a procedure is predicted to be painful,

e.g. uterine artery embolization:

  • Explain this to the patient in advance and reassure them that this is normal and that effective pain control will be provided.

  • Prophylactic analgesia should be given to minimize/prevent it. Combinations of non-steroidal and opiate analgesics are often used.

  • Prescribe appropriate medication before starting (e.g. analgesic, antiemetic, sedative).

  • Have someone check regularly whether the pain control is effective. Give additional analgesia and pain control as necessary. Patient-controlled analgesia (PCA) is useful here.

  • Suitable analgesia should be prescribed for the post-procedural period.

Tip

If you anticipate giving intravenous drugs on several occasions during a procedure, attach a low-pressure connector to the venous access and locate it in an easily accessible position. This means you will not have to interrupt the procedure while someone rummages around under the drapes trying to find a cannula each time a drug is given. Remember that a saline flush is needed or the drug will just sit in the tubing!

If a patient experiences unexpected pain during or after a procedure

  • Establish what is causing the pain and what can be done to resolve it, e.g. stress-related angina may respond to the usual glyceryl trinitrate spray.

  • Treat pain swiftly and effectively. This is not the time for oral paracetamol (acetaminophen); intravenous opiate analgesics are the order of the day, so remember to ensure that venous access is obtained in advance.

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