Patient Info

Preparing for Surgery

Once it has been agreed that an operation is required you need to start to prepare for your surgery and the post-operative period. This will help you to recover as quickly and smoothly as possible. Preparing yourself mentally and physically for surgery is an important step toward a successful result. It is important that you have a realistic expectation of how your recovery will progress. Understanding the process and your role will help you recover quickly and with fewer problems.

Before to your surgery

Before your surgery your medical history will be reviewed and a physical examination undertaken to make sure you do not have any conditions that could interfere with the surgery or its outcome. Routine investigations, such as blood tests and X-rays, will be kept to a minimum. Patients who do require tests, or who require blood to be cross matched, need to have these tests during the week prior to surgery.

It is important that both the surgeon and the anaesthetist know every medical issue that might affect you. What may appear unimportant to you may be essential for us to know. In particular we need to know all the drugs you are taking and this should include any herbal or similar supplement as some of these may have important implications for your surgery. You should bring them to the hospital in their original packet. Unless advised specifically to the contrary you should take all your drugs up to and including the morning of surgery. The exceptions to this are blood thinning agents, such as aspirin, clopidogel and warfarin, and diabetic drugs. These require special arrangements.

If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery.

Report any current infections. Surgery cannot be performed until all infections have cleared up.

Eating and drinking prior to surgery

You must not eat any solid food within six hours of elective surgery. You can drink clear water up to two hours before the start of surgery. You must not suck lollies or chew gum within six hours of surgery.

If your operation is in the morning you must not eat or drink anything after midnight prior to the day of surgery. If your surgery is going to be in the late morning you may be able to drink clear water up to 07.00. However, you can only do this if we give you specific instructions.

If your operation is in the afternoon you can eat breakfast, but must finish all solid food by 07.00. You can drink clear water up to 11.00. If your surgery is going to be in the late afternoon you may be able to drink clear water up to 13.00. However, you can only do this if we give you specific instructions.

The exact order of the list will be finalised 48 hours prior to surgery. If it is appropriate to vary these instructions we will advise you. If you have any doubts or receive conflicting information, adopt a conservative approach and do not eat for six hours prior to the start of a morning (08.00) or afternoon (13.30) list. Clear water only can be drunk from six to two hours prior to start of the list, and nothing within two hours of a list starting.

If you have not been ‘nil by mouth’ correctly it is possible that your surgery will not be able to take place as scheduled.

Pain relief

It is important that before your operation you understand the importance of adequate pain relief and how it can best be achieved. You will not be in the best position to understand what is required while you are still recovering from your anaesthetic.

Proper pain relief is very important for both holistic and physiological reasons. Your post-operative recovery will be slower if you do not have adequate pain relief. Patients often have an understandable reluctance to take pain relieving drugs. This is a mistake and may increase post-operative complications. The principal that underlies all methods of pain relief is that the drugs work best if you anticipate the pain. A small quantity of the drug taken regularly (even if pain free at that time) will work better than waiting for the pain to occur and then taking a larger dose.

If you are having a major abdominal operation the anaesthetist may offer you one of several types of pain relief.

• Epidural anaesthetic - this requires a needle to be inserted into your back and drugs are given through a fine catheter. This will remain in place for a maximum of three days.
• Patient Control Analgesia (PCA) - with this technique you press a button as and when you feel the pain. A small dose of the pain relieving drug is administered.
• Nurse Control Analgesia (NCA) -with this technique the nurses will press a button as and when they feel you require pain relief. A small dose of the pain relieving drug is administered.
• The advantage of all these techniques is that a small quality of the pain relieving drug can be administered on regular basis and prevent the pain rather than treat it after it occurs. This is by far the most effective form of pain relief.
• Alternatively, regular injections can be administered. This is not as effective as they are usually administered after the pain has occurred.

After a couple of days adequate pain relief can normally be achieved by oral medication. Regular panadol, regardless of whether you have pain or not, is the foundation on which other medications are given. Intermittent panadol will not work well. You should use regular panadol to provide background pain relief for a week after your operation. Additional, stronger painkillers and/or anti-inflammatory drugs can then be taken on top of the regular panadol for break through pain. Many strong painkilling medications contain morphine, codeine or a derivative of these drugs. One of the side effects of these drugs is constipation.

You may fine additional information at Prospect web site (www.postoppain.org)

Discharge planning

Before you come into hospital you should think about how you will manage when you go home after your operation. A mother with young children will have different requirements to an older person. An older person will have differing requirements depending on whether they have a fit or unfit partner, or if there is family nearby who can assist.

The following are examples of the sort of matters you need to have considered before you come into hospital:-

• Pre-cooked some frozen meals
• Arranged for someone to help out with everyday tasks like shopping, housework and laundry
• Organised the pets and children
• Paid any outstanding bills

Put items that you use often within easy reach before surgery so you will not have to reach and bend as often.

Remove all loose carpets and tape down electrical cords to avoid falls.

Make sure you have a stable chair with a firm seat cushion, a firm back and two arms.

Day case surgery

If you are having Day Surgery you will need to make additional arrangements. In particular remember the following:

• You must not drive, operate machinery, make important decisions or sign legal documents for at least 24 hours after the operation concludes. These restrictions also apply to patients who have had an overnight hospital stay and are still within the 24 hour post-operative period. This is a legal as well as a medical requirement. For example, if you drive home and have an accident you might be considered to be driving under the influence of drugs, and this may affect your insurance.
• You must spend your first post-operative night within a reasonable distance of the hospital. Patients from the country will need to stay in Perth.
• Someone must also remain with you the first post-operative night.

Do not drink or eat anything in the car on the trip home. The combination of anaesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours.

If you do not fill these criteria, or there are concerns about your recovery from the anaesthetic, it may not be possible to let you go home.