Pain Management after Kidney Stone Surgery

Pain is expected after kidney stone surgery. Most pain can be controlled. Sometimes we cannot help a child to be totally pain free, but we will help each child be as comfortable as possible. 

The hours immediately after surgery can be a challenging time for managing pain. When your child wakes up in the peri-anesthesia care unit (PACU), they may feel discomfort in their side/back near the kidney that had the stone and low in the abdomen near the bladder.

When your child returns home, some movements may cause discomfort or make them feel like they must urinate (pee). They may feel pressure or discomfort before, during or even after urination. Your child’s urine will likely appear pink or red due to blood in the urine. 

Patient instructions: 

Before you give your child any pain medicine, ask your child to rate their pain on a scale of 0 to 10. A rating of zero means no pain. A 10 means this is the worst pain your child has ever had.

We want to reduce the amount of pain your child experiences. If your child has pain, our goal is that it is no more than 5 on the pain scale. To achieve this goal, we have a multi-tiered approach to reducing pain:

1. Recognizing pain

2. Reducing pain without medicines

3. Reducing pain with medicines

1. Recognizing pain in your child

Children may show different behaviors when they are in pain. They may: 

• Become quiet. 

• Have trouble sleeping. 

• Eat or drink less than usual. 

• Lose interest in family and friends. 

• Become less active (lie quietly or curl up in bed). 

• Be irritable, restless, or angry. 

• Complain of pain. 

• Hold or protect the area of discomfort.

2. Reducing pain without medicines

Increase water intake

Your child should drink plenty of water and clear fluids throughout the day to keep urine dilute or pale yellow in color. This may mean that they will pee more frequently, but it will help with pain management.

Create a comfortable and safe environment. 

• Dim the lights. 

• Offer to stay with them. 

• Reduce noise. 

• Provide quiet time.

• Talk in a calm, soothing voice.

• Use touch to provide comfort and security.

• Offer to massage your teenager’s back.

• Offer a hug.

• Offer to hold your child’s hand.

Other helpful hints to reduce pain:

Use distraction to help your teenager focus on something other than their pain. 

• Listen to music.

• Take slow, deep breaths.

• Read a book. 

• Talk about a favorite experience or memory. 

• Play a game.

• Watch TV.

• Create an art project.

• Draw or color.

3. Reducing pain with medicines

• We will recommend over-the-counter medicine such as ibuprofen and acetaminophen. 

• We may also prescribe other medicines as needed, these will be sent electronically to your pharmacy, and you will need to pick them up when filled. 

• Your child should take all medicines as directed by your surgeon.

• Take the medicines as ordered: Consider “stacking” medicines by giving them every 6 hours but alternate ibuprofen (9am, 3pm, 9pm, 3am) and acetaminophen (6am, 12 noon, 6pm, 12 midnight) so that your child has consistent pain medicine coverage. Keep track of which medicine you gave and the time you gave it. You do not want to give too much of either medicine.

Below is a list of medicines that your child may take after surgery:

Acetaminophen (Tylenol®) is a pain reliever. 

• Your child may have it every 4 to 6 hours as needed for mild to moderate pain. 

• We recommend that your child take acetaminophen (Tylenol), every 4 to 6 hours for the first 3 days after surgery or as long as the stent is in place. After the first 3 days, give only as needed.

• Follow the dosage instructions on the label

Ibuprofen (Motrin® or Advil®) is a pain medicine that is sometimes used to treat pain and swelling. It is important to ask your surgeon if your child is allowed to take ibuprofen, please follow the guidelines below: 

• Your child may have it every 6 hours as needed for mild to moderate pain. 

• We recommend that your child take Ibuprofen (Motrin/Advil), every 6 hours for the first 3 days after surgery or as long as the stent is in place. After the first 3 days, your child should only take it as needed, never more than every 6 hours. 

• Follow the dosage instructions on the label. 

Oxybutynin (Ditropan®) is a medicine that reduces bladder spasms that may occur related to the placement of a ureteral stent. 

• Your child may have it every 8 hours as needed for bladder spasms.

• Follow the dosage instructions on the label. Take only as needed every 8 hours as long as the stent is in place.

• Side effects from this medicine include over-heating, flushing or redness of the skin and constipation. It is important that your child drinks plenty of fluids while on this medicine to decrease the occurrence of possible side effects. 

Tamsulosin (Flomax®) is a medicine that reduces bladder spasms that may happen if a ureteral stent is used.

• Your child may have it once a day as needed for bladder spasms.

• Follow the dosage instructions on the label. Take only as long as the stent is in place or as instructed by your urologist.

• Side effects from this medicine include a feeling of lightheadedness when standing. 

Some children are unable to take ibuprofen or have pain that requires a stronger medicine. In this case we will prescribe another medicine:

Tramadol is an opioid (narcotic) medicine. It is a strong pain medicine that requires a prescription. 

• Your child may have it every 6 hours as needed for moderate to severe pain (5 or more on the pain scale). 

• By law, prescriptions for opioids cannot be “called in” to the pharmacy, they must be electronically prescribed. 

• If you think you need to refill the opioid prescription, you will need to bring your child in for an appointment in our office.

• Tramadol is available only in pill form and the immediate release may be crushed if your child is unable to swallow pills.

Oxycodone is an opioid (narcotic) medicine. It is a strong pain medicine that requires a prescription. 

• Your child may have it every 4 hours as needed for moderate to severe pain (5 or more on the pain scale). 

• By law, prescriptions for opioids cannot be “called in” to the pharmacy, they must be electronically prescribed. 

• If you think you need to refill the opioid prescription, you will need to bring your child in for an appointment in our office.

• Oxycodone is available as a pill and a liquid. Not all pharmacies carry the liquid form. If your child cannot swallow pills, check with your pharmacy before surgery to ask if they have oxycodone liquid.

There are risks related to taking an opioid medicine:

• There is a risk of addiction and overdose. This risk is higher in people who suffer from mental health or substance use disorders.

• It is dangerous to take a controlled substance containing an opioid with benzodiazepines (such as diazepam), alcohol, or other depressants.

• There is a risk of constipation making it hard for your child to have a bowel movement (poop). It is important to make sure that your child eats a healthy diet including fruits, vegetables and whole grains for good fiber intake and drinks plenty of water. 

Any time your child takes medicine, there is a chance that they will have side effects. Here are some things to watch out for:

• Allergic reactions: Signs of an allergic reaction are itching, hives, or rash. If your child has any of these, stop the medicine and call your surgeon’s office.

• Nausea: Some medicines make children feel sick to their stomach. To prevent this, have your child eat before taking the medicine. If your child vomits after taking medicine, please wait the prescribed amount of time before giving another dose of the medicine. 

• Constipation: Some pain medicines make it hard for children to have bowel movements. If your child does not have a bowel movement, have them eat more foods with fiber such as fruits, vegetables, and whole grains. Your child should also drink lots of water. 

Call your CHOP urology team with questions or concerns.

Division of Urology

Monday-Friday 8:30am – 4:30pm: 215-590-2754 

Weekends, Evenings, Holidays: 215-590-1000. Ask to speak with the urology provider on call.

Reviewed February 2024 by Lauren Schutz, PA-C