Pain relief after cleft surgery

Paracetamol and diclofenac suppositories, and oral morphine

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Pain relief after cleft surgery Paracetamol and diclofenac suppositories, and oral morphine (268kB pdf)

Information for parents and carers

Your baby may have a sore mouth for up to 2 weeks following surgery. Pain may be worst for the first 4 days after their operation and after that it should start to improve day by day.
Giving pain medicine (analgesia) is the most effective way of relieving this pain.
We recommend using suppositories for pain relief after cleft surgery. This is a good way to give your baby pain relief when their mouth is sore. Using suppositories can be less distressing for your baby than oral medicine.
We recommend giving pain relief regularly for the first few days at home. This will help your baby return to their normal routine and help with feeding and sleeping. Your baby should still be able to drink from their special bottle or feeder beaker.

The below information shows a good way of giving your regular pain relief at the right time.

6am – PARACETAMOL and DICLOFENAC.
12pm Midday – PARACTAMOL only.
6pm – PARACETAMOL and DICLOFENAC.
12am Midnight – PARACETAMOL only.

Your baby should start to feel less pain about 30 minutes after having pain relief. It may take up to an hour for the medicine to work properly.
Giving paracetamol and diclofenac at the same time is safe. Morphine is available to be given if required – if your baby still has pain an hour after having a suppository, you can give them a dose of oral morphine if one is due.

As your baby’s pain improves

After a few days, you may notice that your baby seems to have less pain. Your baby may not be getting sore as each dose of pain relief wears off. They may be more contented, feeding well and sleeping better.
At this stage you may have used all the diclofenac suppositories. You should still continue to give the paracetamol suppositories regularly.
The hospital will provide enough paracetamol suppositories for the first week after your baby’s operation.
When you have used all the paracetamol suppositories your baby’s mouth should be healing. You can change over to giving your baby paracetamol suspension by mouth, if they still need pain relief. Please give the dose on the side of the bottle.

General safety information about pain relief

Do not give extra doses of medicine, as this can be dangerous.
Only give these doses to your baby. Do not give these doses to anyone else, even if their condition appears to be the same, as you could do them harm.

Safety information about PARACETAMOL

You must not give your baby more than four doses of paracetamol in 24 hours. Do not give extra doses of paracetamol suspension by mouth whilst using the paracetamol suppositories.

What if I forget to give PARACETAMOL?

If your child is in pain, give the missed dose as soon as you remember. You must then wait at least 6 hours before giving the next dose.

Safety information about DICLOFENAC

You must not give your baby more than two doses of diclofenac in 24 hours. Do not give extra doses of ibuprofen suspension by mouth whilst using the diclofenac suppositories.
Your baby should drink plenty of fluids, such as water, while they are taking this medicine. If your child becomes dehydrated (not enough water in the body), diclofenac may affect their kidneys. You will know if your baby gets enough fluids if they have the same number of wet nappies after surgery as before. Your child should have a wet nappy at least every 8 hours. If there are fewer wet nappies, contact your cleft nurse specialist.

What if I forget to give DICLOFENAC

If your child is in pain, give the missed dose as soon as you remember. You must then wait at least 12 hours before giving the next dose.

Safety information about MORPHINE

You must not give your baby more than four doses of morphine in 24 hours. Do not give morphine if your baby is sleepy.

What if I forget to give MORPHINE?

You only need to give morphine if your baby has pain. You must then wait at least 6 hours before giving the next dose.

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.

This information can be made available in other languages and formats if requested.