You will be admitted to hospital shortly before the operation, usually the afternoon before but sometimes on the day of surgery. You will be seen by the ward staff and anaesthetist.
You may be asked to phone the hospital to make sure that a bed is available for you.
Please ensure you bring all your medication, toiletries, clothing, etc. You will be unable to eat or drink for six hours before surgery.
Please make sure you tell your GP you will be in hospital, as they may be able to help you prepare for coming home again and may wish to visit you after discharge.
Generally you should continue all you medication until admission to hospital.
Some patients take “low-dose aspirin” for chest pain or to prevent a small stroke or TIA - typically a low dose of 75mg (half a junior aspirin). If you are taking low-dose-aspirin, you should continue taking this as usual until the time of your admission (unless your medical team advises otherwise) and low-dose-aspirin will probably continue immediately after surgery.
If you are on a higher dose of aspirin please discuss this in the pre-admission clinic.
One exception to continuing your regular medication, is if you are taking non-steroidal anti-inflammatory drugs (NSAIDS) such as stronger aspirin, Brufen™, Nurofen™ (Ibuprofen) Voltarol™ (Diclofenac) and Naprosyn™ (Naproxen). These affect your blood-clotting factors.
You should stop taking these drugs for at least 10 days before surgery and use alternative painkillers.
Some patients with rheumatoid arthritis take a drug called methotrexate, which may need to be stopped a week or so before surgery. Some diabetic drugs (such as Metformin) need to be stopped a couple of days before surgery too.
Please seek further advice about these drugs in the pre-admission clinic.
To prevent you from getting a deep vein thrombosis or pulmonary embolism you will be asked to wear "anti-embolism stockings" for a period of six weeks.
You may receive a daily injection with anticoagulant in your belly and you should take 75 mg of aspirin each day for six weeks, unless contra-indicated.
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Your surgery will be performed under general and / or regional anaesthesia. Your anaesthetist will discuss this with you before surgery.
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Before your operation your anaesthetist will visit you in the ward. The anaesthetist who looks after you on the day of your operation is the one who is responsible for making the final decisions about your anaesthetic.
He or she will need to understand about your general health, any medication that you are taking and any past health problems that you have had. Your anaesthetist will want to know whether or not you are a smoker, whether you have had any abnormal reactions to any of the drugs or if you have any allergies.
They will also want to know about your teeth, whether you wear dentures, have caps or a plate. Your anaesthetist needs to know all these things so that he or she can assess how to look after you in this vital period.
Your anaesthetist may examine your heart and lungs and may also prescribe medication that you will be given shortly before your operation, the pre-medication or 'pre-med'.
Pre-medication.
This medication (drugs) may be given to you some hours before your operation. These drugs may be given as tablets, injections or liquids (to children). They relax you and may send you to sleep. They are not always given.
Do not worry if you do not have a pre-med, your anaesthetist has to take many factors into account in making this decision and will take account of your views on the topic if possible.
When your anaesthetist visits you before your operation, this is the time to ask all the questions that you may have, so that you can forget your fears and worries.
Before your operation you will usually be changed into a gown and wheeled to the operating suite into an anaesthetic room. This is an ante-room outside the theatre. The anaesthetist, his or her assistant and nurses are likely to be present.
An intravenous line (drip) may be inserted. Monitoring devices may be attached to you, such as a blood pressure cuff or a pulse oximeter. A pulse oximeter is usually a little red light in a small box, which is taped to your finger. It shows how much oxygen you have in your blood and is one of the vital monitors that an anaesthetist uses during your operation to ensure that you remain in the best of health. You may be given some oxygen to breathe.
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During general anaesthesia you are put into a state of unconsciousness and you will be unaware of anything during the time of your operation.
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While you are unconscious and unaware your anaesthetist remains with you at all times. He or she monitors your condition and administers the right amount of anaesthetic drugs to maintain you in the correct level of unconsciousness for the period of the surgery.
Your anaesthetist is constantly aware of your condition and trained to respond. Your anaesthetist will be monitoring such factors as heart rate, blood pressure, heart rhythm, body temperature and breathing.
He or she will also constantly watch your need for fluid or blood replacement.
If you have any other medical conditions, your anaesthetist will know of these from your pre-operative assessment and be able to treat them during surgery.
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For regional anaesthesia a local anaesthetic drug is injected around a bundle of nerves so that a part of the body, such as an arm or a leg, is made numb. In addition, the muscles in the limb are paralysed whilst the drug is acting so that the limb becomes floppy.
Obviously you will still be awake and know that the operation is taking place, but often the anaesthetist will administer a sedative drug so that you drift off to sleep during the operation. Even if this is not the case, you will not be able to see the operation because a screen will be placed in the way.
Examples of regional anaesthesia are the use of an epidural for pain relief during childbirth, a spinal for an operation on the bladder, hip or knee, and an eye block for cataract surgery. Sometimes regional and general anaesthesia are combined, particularly for major surgery, to provide pain relief after the operation.
Just as for General Anaesthesia, your anaesthetist remains with you throughout the operation under regional anaesthesia, monitoring and controlling your anaesthetic state throughout in the same way. Similarly, you will go to the recovery ward afterwards until you are stable and safe to go back to the ward.
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Surgery.
The operation itself usually takes a one to 1 ½ hours, but you will not be back on the ward for at least three to four hours because you will spend some time in the recovery room, which is next to the operating theatres.
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After your operation, you will wake up in the recovery room. You might have an oxygen mask on your face to help you breathe; you might also wake up feeling sleepy, both of which are normal.
If you had a hip replacement you may have a triangular pillow between your legs.
Following a total knee replacement you may a bulky dressing around your knee. This will be removed on the first post-operative day.
You may have a small, plastic tube in one of the veins in your arm. This is often attached to a drip (bag of fluid), which gives you fluid and antibiotics. Additional pain relief or a blood transfusion can also be given through this drip.
While you are in the recovery room, a nurse will check your pulse and blood pressure regularly. When you are well enough to be moved, you will be taken to your ward.
Sometimes, people feel sick after an operation and might actually vomit. If you feel sick, please tell a nurse and you will be given some medicine to try and stop the sickness/vomiting.
You may have one or two drains (tubes) coming from your wound. These are attached to a bottle and for a few hours after surgery collect the fluid that seeps from the operating site. Sometimes the blood collected may be used for re-transfusion.
Some patients also have a urinary catheter (a tube into the bladder) for a while.
Once you are fully awake you will be returned to the ward.
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Everybody recovers at different speeds, dependent on your age, your general health and the nature of your surgery.
As soon as you wake up after surgery and are able to, you should start wiggling your toes and feet, bending your foot up and down, ten times every half an hour. This helps the circulation in your calf. You can try to bend your knee gently.
You will be allowed to sit up at approximately 40º in bed. For the first few days, you should do regular deep breathing exercises, to keep your lungs expanding, and to prevent a chest infection.
The wound is covered with a white absorbent or clear plastic dressing. Sometimes, fluid accumulates under this dressing, which can be easily drained.
Little metal staples are used to close the wound, which are removed after you have returned home, around 2 weeks after the surgery.
The day after surgery, the drain tubes will be removed, if drains have been used.
The physiotherapist will visit you and help you to stand, and possibly, walk on your new hip or knee.
On the second day, the physiotherapist will get you walking with crutches.
For patients with a hip replacement you will soon be able to get out of bed and sit in a high chair and use the toilet with a raised seat. At this stage, you must not sit on a low chair. This is because it would allow your hip to bend too far and could dislocate the new hip.
Patients with a total knee replacement will be encouraged to bend their knee as soon as possible.
Until you are ready for discharge home, you will be encouraged to be as independent as possible with the help of the nurses and physiotherapists.
Please think about your home environment before you leave hospital and discuss any problems with the occupational therapist, medical staff, nursing staff, or physiotherapist.
With acknowledgement to
