Immediate post-op period: You will be moved from the Recovery Room back to your ward room as soon as we ensure that you are properly awake and comfortable. Most patients continue to feel drowsy for some hours after surgery and it is common to have mild discomfort in the operative site. Nausea, a mildly sore or dry throat and mild headache affect some patients, and these symptoms can be treated if needed. Most patients having day case operations will feel ready to drink, take a light meal and get out of bed within 2-4 hours. Those having more major operations will be more drowsy, usually because the operation has been longer and a strong pain-killer (usually morphine) has been given in theatre, with further doses needed in the first 24 hours.
Pain relief: A regime to prevent and control pain is individualised for each patient. This usually involves giving local anaesthetic to numb nerves in the operative site while you are asleep, plus strong pain-killers given intravenously as part of the anaesthetic. These pain-killers include morphine or morphine-like medicines and an anti-inflammatory, as long as these are considered safe for you. After surgery, paracetamol is given, normally four doses in 24 hours. Although not strong enough on its own to prevent or relieve all post-surgical pain, paracetamol clearly reduces the amount of stronger pain-killers needed, and thereby reduces the risks of side-effects from these.
If you are able to take an anti-inflammatory pain-killer (ibuprofen, diclofenac), this is also usually prescribed. The combination of paracetamol and anti-inflammatory is often enough to keep you comfortable, especially after a day-case procedure such as arthroscopy. When something stronger is needed, or if you can't take an anti-inflammatory because of side-effects, morphine or codeine is added. Morphine is usually given as a pump connected to your intravenous line, with a handset attached allowing you to give yourself small doses as needed ("patient-controlled pain-relief pump"). Codeine is given, by tablets or suppository, when the morphine pump is not considered necessary or when the intravenous line has been removed, usually 24-36 hours after surgery. Morphine and codeine have more side effects than other pain-killers (nausea, vomiting, constipation and drowsiness) and are stopped as soon as you no longer need them.
Some patients having major abdominal surgery have an epidural for postoperative pain control (see above), and have a continuous drip of local anaesthetic into the epidural tube for 2-5 days after surgery.
When you leave hospital, some of the pain-killing tablets described above may be prescribed. To minimise side effects you should use paracetamol first, adding an anti-inflammatory if paracetamol is not enough. If codeine is prescibed, use it only if paracetamol and the anti-inflammatory are not enough. You are more likely to need it if you can't take the anti-inflammatory. Some medicines (Cocodamol, Codydramol, Coproxamol) contain both paracetamol and a codeine-like medicine: if taking these you should not take plain paracetamol as well.
Side effects of paracetamol at normal dosage are very uncommon. Anti-inflammatory medicines can cause stomach upset (indigestion, cramps). This is more common after 2-3 days of treatment and can be reduced by taking the tablets with food or reducing the dose. They can aggravate a bleeding tendancy, cause stomach bleeding and affect kidney function. If you have a history of gastric or duodenal ulcer, bleeding problems or kidney disease they are contra-indicated.
Private patients please note that insurance companies don't usually cover the cost of take-home pain-killers. The hospital charges for these, including the added cost of having the pharmacist deal with the prescription, so it is cheaper if you buy a few days' supply of paracetamol and ibuprofen (if you can take it) at a chemist's or supermarket before you come into hospital.
Current advice in the UK is that you should not drive or operate power tools or any potentially dangerous machinery within 24 hours of your anaesthetic, because of reduced hand-eye co-ordination and reaction times. Some authorities suggest that 48 hours is safest. It is also prudent not to drink alcohol during the first 24-48 hours since adverse effects of both the alcohol and of pain-killing drugs may be increased.
Copyright J R Klinck