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Preoperative and Postoperative Information

 

 

 

Pre-Operative Information

 

 

 

Medical Assessment

 

 

You will be reviewed in a preassessment clinic before surgery to have baseline blood investigations and electrocardiogram. If there are general health concerns (with the heart or lungs for instance)  an arrangement will be made for review by an anaesthetist or a physician at the hospital where the surgery will take place. This provides for specialised care in the immediate post-operative period, helping reduce the risk of complications.

 

 

Medications

 

 

Some medications have a major impact on surgery and the early post-operative period. Amongst the most important are medications that reduce clotting (“thin the blood”) and these may need to be stopped before surgery because of possible bleeding problems. This group includes warfarin, clopidogrel, all aspirin containing medications and all of the non-steroidal anti-inflammatory drugs (NSAIDS). Warfarin and clopidogrel are usually stopped 7 days before surgery whilst Aspirin and the NSAIDS are to be discontinued 5 days before the procedure. However, do not stop taking any medicines before discussing them with your surgeon.

 

 

Allergies

 

 

Always tell your surgeon about any allergies to drugs so as to avoid potentially serious problems.

 

 

Admission to Hospital

 

 

Once a plan for surgery has been decided upon, bookings will be made with the appropriate hospital. In most cases, admission to hospital is either on the morning of the day of surgery or in the early afternoon. Nursing staff will supervise preparations for surgery on the ward and the anaesthetist will make a visit shortly before the time of surgery. You will be asked to sign a consent form if you have not done so in the preassessment clinic and the operating site will be marked.

 

 

 

Post-Operative Information

 

 

 

In-Hospital

 

 

  • Pain relief - Local anaesthetic is used in the wound to help reduce the pain from the cut in the soft tissues. This will be backed up by use of morphine and related drugs to take away the severity of the pain from the surgery. Often, the delivery of these drugs is controlled by the person who has had the surgery by way of a button attached to a pump
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  • Mobilising - Sitting up is encouraged very soon after surgery as it allows better breathing and oxygenation. Standing and walking are started the day after surgery and may be supervised by the physiotherapist in the first instance
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  • Stitches and dressings - I use buried, absorbable stitches in the skin that do not require removal. In the first few days after surgery, the dressing may become soaked by fluid from the wound and therefore require changing. Before discharge from hospital a clear, rubbery dressing will be applied that can stay on for a week or more until the wound heals. Showers may be taken during that time.
  • Nerve pain - Although many people experience immediate pain relief following surgery, it is not unusual for a subset of patients to have residual pain that could take weeks to settle. This is due to nerve inflammation as a result of the original compression or the surgery.

 

 

First Two Weeks

 

 

  • Expected levels of pain - The operative site will be sore, but will continue to gradually improve.
  • Wound care - Leave the dressing that was applied at discharge from hospital intact. It should be removed 10-14 days after the day of surgery
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  • Activity level - It is best to keep active. Walking on level ground without pushing beyond your comfort zone is advised. Lying down all the time leads to loss of muscle tone and increased medical complications
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  • Pain relief - Tablets will be prescribed at the time of discharge and should be taken as directed
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  • Emotions and tiredness - It is not unusual to feel down after an operation and so allow for this in your plans when you leave hospital. Your spirits will naturally improve with a little time and gentle activity
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  • Travelling in a car - Being a passenger in a car will not harm your neck or back, but may make them painful. If trips in a car are necessary, then try to make them short or break them up with stops for a walk at least every hour.

 

 

Subsequent Month

 

 

  • Return to work: People with non-manual jobs will normally return to work after 2-4 weeks. For those with physically demanding work, resumption of work will take 3 months.

  • Driving a car: Do not expect to drive any vehicle until 3-4 weeks after surgery. This is because pain in the neck or back could prevent you from controlling the vehicle safely. If you are unable to make an emergency stop or the pain prevents you from being in control of your car at all times, then you will have problems with your insurance company.
  • Flying: You should not fly for 2 weeks post surgery. You should avoid long haul flights for 4-6 weeks. If travelling on a long haul flight within 6 months of your procedure then you should wear your hospital stockings when flying. Try to keep yourself hydrated and move your legs and mobilise regularly on board.

 

 

Long term

 

  • Recovery of function - Full recovery often depends on commitment to regular exercise in order to build up muscle and stamina that was lost due the original condition and then the surgery