YOUR GUIDE TO

SURGERY
An essential guide to support you through having
major or complex surgery at UHCW
 This publication includes text taken from the Royal College of
Anaesthetists’ (RCoA) leaflets ‘You and your Anaesthetic 2014,
Anaesthesia Explained 2015, Preparing for surgery: Fitter Better
Sooner 2018’ but the RCoA has not reviewed this as a whole

The full RCoA resources can be accessed by the link below, or by using
this QR code

QR codes are 3D barcodes. Most smartphones can read a QR code, to

create a quick link to a website or other resource. All you have to do is

1. Open your phone’s camera app

2. Point the camera at the QR code –
it should recognize it and pop up
the website link.
3. If it doesn’t work, free apps such
as Google Lens can be
downloaded to do this
4. The website address will always
be typed next to the QR code just
in case.

https://www.rcoa.ac.uk/patient-information/patient-information-resources

If you are accessing the electronic version, you can just tap
the QR code to follow the link
 CONTENTS
Page
Getting the best results 5

Your pathway to surgery 21

Your Anaesthetic 37

Managing your pain 55

After the operation 71

This document is a shortened version. A longer version is

available by scanning or tapping the QR code below

https://www.uhcw.nhs.uk/our-services-and-people/our-
departments/anaesthetics/
The Trust has access to interpreting and translation services. If you need
this Information in another language or format please contact 024 7696
6352 and we will do our best to meet your needs.

The Trust operates a smoke free policy

Document History
Department: Perioperative Medicine
Contact: Dr George Madden
Updated:
Review:
Version:
Reference:

Using the electronic version of this document

When using this document online or as a pdf, you will see underlined
“hyperlinks” which can take you to external webpages or other parts of this
booklet.

There are also two arrows in the bottom left-hand corner:

This arrow will take you to the main Contents page

This arrow will take you to the first page of the Chapter you’re
reading
 Getting the best
results
To get the best results from your surgery, it is vital that you
understand what you can do to help yourself. This section
will explain why surgery doesn’t always go to plan, and
then explain what you can do to get the best outcome from
your surgery.

Contents Page

Why surgery can be “complicated” 6

The impact of having a complication after 7

surgery

How you can improve your health and 13

fitness before surgery:

Getting the best results

Exercise 14

Diet 15

Weight loss 17

Alcohol 18

Smoking 18

Personal hygiene 19

Your Guide to Surgery

5
 Why surgery can be
“complicated”
After surgery, you may develop a problem that would keep you in
hospital for longer. We call these “complications”. This may be
something that seems unrelated to the operation itself, but
increasingly evidence shows that these occur as a result of the
body’s response to surgery. These problems may include

• Chest infections (pneumonia)

• Urinary tract infections

• Wound infections

• Kidney problems

• Heart attacks (myocardial infarctions)

• Strokes
Getting the best results

Most people will go through surgery without any of these

happening, but when there is a complication, we need to act
quickly to treat it.

You will have a pre-operative assessment, where we will identify

whether you are at risk of any particular complications, and we
will advise on what can be done to help prevent these from
happening.

Your Guide to Surgery

6
The impact of having a
complication after surgery
We often refer to the ability of a person to exercise and look after
themselves (e.g. getting washed, dressed, going to the toilet,
cooking) as their “Functional Status”.

Below a certain threshold, the person becomes dependent on

others. The aim of most surgery is either to improve functional
status (such as improving mobility with a hip operation), or to
extend life.

When complications occur, surgery to extend life may end up

reducing functional status, and surgery to improve functional
status in one regard (such as a hip replacement improving
mobility) may reduce functional status in another way (such as
becoming more breathless due to lung problems).

The evidence is developing all the time, but what we think

Getting the best results

happens can be described with the diagram below:

Your Guide to Surgery

7
 Your Guide to Surgery
8
Getting the best results
The blue line is a typical patient

They have a generally good functional status when they are given
their diagnosis and told they need surgery. They can look after
themselves and enjoy an active life. This continues until just
before surgery. The operation then reduces their functional status
as they are dealing with pain, and reduced mobility while they
recover. They fall below the “Threshold for Dependency” – the
level at which they need help with daily tasks such as washing
and dressing. With time they recover and get back to normal. As
years go by, however, their functional status will gradually drop
with age.

Getting the best results

Your Guide to Surgery

9
 The purple line is someone with
serious health problems
Their functional status may be worse, and though they may follow
the same course as the typical patient, because they are already
closer to the threshold for dependency, it takes them that much
longer to recover their independence.
Getting the best results

Your Guide to Surgery

10
The red line is a typical patient
who has a serious complication

They start off following the same course as the “typical” patient,
but a week after surgery, their functional status has taken an extra
“hit” from that complication.

Their recovery is slower, and they never get back to where they
were before surgery.

They are more likely to need help with their usual activities in the
longer term.

Getting the best results

Your Guide to Surgery

11
 The green line is someone who
has improved their health and
fitness before surgery
They have a better functional status before surgery, a bit like
training for a marathon, and then, though they drop the same
amount as the typical patient, they manage to stay independent.

They can get up and about sooner after surgery, are less likely to
have a complication, and are more likely to return not just to their
original functional status, but may actually maintain that extra
fitness they gained just before surgery.

This is becoming known as “prehabilitation”, and is an approach

that is becoming established throughout the UK.
Getting the best results

Your guide to surgery

12
How you can improve your
health and fitness before surgery

There are many changes you can make to reduce the risks of
surgery. Even small changes can make a big difference. The
longer your wait for surgery, the more you’ll be able to achieve,
but even a couple of weeks can make a difference.

You should try to

• Exercise more

• Improve your diet

• Lose some weight

• Reduce your alcohol intake

• Stop smoking

• And in the days up to your operation, you should pay attention

Getting the best results

to your personal hygiene

Your guide to surgery

13
 Exercise
Your heart and lungs have to work harder after an operation to
help the body to heal. If you are already active, they will be used
to this. If you are not very active, it is a good idea to use the time
while you are waiting for your operation, try and increase your
activity levels.

Brisk walking, swimming, cycling, gardening or playing with your

children are all helpful. Try to do any activity which makes you feel
out of breath at least three times per week, but always check with
your doctor first what type of exercise is most appropriate for you.
Activities that improve your strength and balance will also be
useful for your recovery.
Getting the best results

You can find out more by scanning this QR code:

Or you can type this link into your browser

https://www.nhs.uk/live-well/exercise/

Your Guide to Surgery

14
Diet

Your body needs to repair itself after surgery – eating a healthy

diet before and after your surgery can really help.
• Eat regularly through the day.
• Base your meals on starchy carbohydrate foods such as bread,
potatoes, pasta, rice, breakfast cereals, noodles, chapatti, naan
or yam. Wholegrain and higher fibre varieties are better choices
if possible.
• A third of your daily intake should be from fruit and vegetables.
Aim for five portions a day. If you are struggling with this, you
could also try multivitamins.
• Eat 2 portions of fish per week one of which is oily (salmon,
sardines or pilchards for example)
• Include two servings of dairy foods a day, for example, milk,
cheese, yoghurts or calcium fortified soya products daily to
keep your bones and teeth strong. Low fat versions will provide

Getting the best results

less calories.
• Include two servings of protein rich foods a day, for example,
meat, poultry, eggs, pulse vegetables, nuts, seeds, Quorn®, or
soya alternatives every day.
• Remember to drink plenty of fluids as this will help keep your
bowels regular. Aim for at least eight glasses of non-alcoholic
drinks a day, for example, water, diluted squashes, fruit juice,
fizzy drinks (preferably diet to avoid extra calories), tea or
coffee.

Your Guide to Surgery

15
 Your Guide to Surgery
16
Getting the best results
Weight loss

If you are overweight, losing weight can help reduce the stress on
your heart and lungs. It can also help you to:

• lower your blood pressure

• improve your blood sugar level

• reduce pain in your joints

• reduce your risk of blood clots after surgery

• reduce your risk of wound infections after surgery

• allow you to exercise more easily.

You can find out more by scanning this QR code:

Getting the best results

Or you can type this link into your browser

https://www.nhs.uk/live-well/healthy-weight/
If you are local to the Coventry area, you can also go to:
https://hlscoventry.org/our-services/healthy-weight/

Your Guide to Surgery

17
 Alcohol You can find out more by
scanning this QR code:
Alcohol can have many
effects on the body, but
importantly it can reduce
the liver’s ability to
produce the building
blocks necessary for
healing. Make sure you
are drinking within the
recommended limits, or Or you can type this link into your
lower, to improve your browser
body’s ability to heal after https://www.nhs.uk/live-well/alcohol-
surgery. support/

Smoking You can find out more by

Getting the best results

scanning this QR code:

Stopping smoking is hard,

but the good news is that
quitting or cutting down
shortly before surgery can
reduce length of stay in
hospital, improve wound
healing and lung function.
Preparing for surgery
Or you can type this link into your
offers a real opportunity to browser
commit to stopping https://www.nhs.uk/live-well/quit-
smoking. smoking/

Your Guide to Surgery

18
Personal hygiene

Wounds heal more quickly if your body is clean and healthy just
before the operation.

• Shower or bath: You are advised to shower or bath using

soap, either the day before or on the day of surgery. If you are
in hospital you will be given help to do this, if you need it.

• Keeping warm: If your temperature is low just before or during

your operation you may be at higher risk of an infection
developing in your wound. Therefore, you should try and keep
warm whilst sitting waiting for your surgery in hospital by
bringing in a dressing gown, slippers, pyjama bottoms etc from
home to wear whilst waiting.

• Shaving: For most operations, you will not need to have the
hair around the site of the operation removed. However, if your

Getting the best results

healthcare team do need to remove hair (to allow them to see
or reach the skin) it should be done by the healthcare
professionals caring for you on the day of the operation using
electric hair clippers with a disposable head. You should not try
to do this yourself.

Your Guide to Surgery

19
 Your pathway to
surgery

Having surgery is about much more than the operation

itself. To get the best results, you may need many different
teams to work with you at different points. This section will
explain all the people that may be needed to guide you
along the first steps of this pathway.

Contents Page

Your healthcare team 22

Your role 23

Your pathway to surgery

Pre-operative assessment 24

Phase 1: Risk Evaluation 26

Once we’ve completed your Risk 29

Evaluation

Phase 2: Preparation 30

Medical conditions and surgery 31

Deferring your surgery 34

Making plans to go home 35

Your Guide to Surgery

21
 Your healthcare team

Many healthcare professionals from different medical specialties

will work together to make your surgery and recovery go
smoothly. They will look after you before, during and after your
surgery. This is often referred to as the perioperative team. But it
all starts with you.

The perioperative team might consist of:

Practice nurses Ward Nurse

GPs Ward Doctors

Your pathway to surgery

Specialty nurses Anaesthetists

You
Elderly care
Surgeons
physicians

Critical Care Physiotherapists

Pre-operative
assessment
nurses

Your Guide to Surgery

22
Your role

Having surgery is a big moment in your life and it’s normal to feel
anxious about it. Fitter patients who are able to improve their
health and activity levels recover from surgery more quickly. What
you do now can have a really big impact on your recovery. Taking
an active role in planning and preparing for your operation will
help you feel in control, leave hospital sooner and get back to
normal more quickly.

Giving consent

Before having a planned operation, your consent should be

obtained by the surgeon well in advance of your surgery. This is
to ensure you have plenty of time to examine any information
about the procedure and ask questions.

Your pathway to surgery

You will be asked to sign a consent form; please ensure that you
understand the procedure, risks and your options before signing
the form. It is important that you completely understand the
information and are an active partner in your care. You will be
given several opportunities to ask any questions you may have.
There will be a copy of the signed consent form for you to keep.
Please ask for it at the time of signing.

Remember you can withdraw your consent if you change

your mind at any point before the operation.

Your guide to surgery

23
 Pre-operative assessment
If you are having a planned operation (rather than emergency)
you will usually be invited to a pre-operative assessment clinic
before your surgery. This is to check if you have any medical
problems that might need to be treated before your operation, or if
you'll need special care during or after the surgery.

University Hospitals Coventry and Warwickshire is constantly

reviewing and updating its pre-operative pathway in response to
the latest evidence and in order to best meet the needs of
patients. As such, your pathway may be slightly different to what
is described here.
Your pathway to surgery

Your Guide to Surgery

24
Why do I need a pre-operative assessment?

Most surgery involves damaging parts of your body in a very

controlled way in order to treat, replace, or remove the diseased
parts. Most types of surgery aim to do as little harm as possible
(such as keyhole surgery), but even so, just like when you are
injured in any other way, the body needs to heal.

Healing needs your heart and lungs to work harder to get oxygen
into, and around your body to the healing tissues. Any long-term
illnesses affecting your heart or lungs can make the operation
more risky for you. This can result in “complications” occurring.
There’s more detail on this in the section “Getting the best
results”.

In addition, having a general anaesthetic is a bit like putting your

brain into a standby mode – things that it does in the background
(such as controlling your breathing, heart rate, and the size of
your blood vessels) get switched off, in a way that is similar to
being put on life support. Your anaesthetist is a highly specialised

Your pathway to surgery

type of doctor who is expert at managing this during your
operation, and safely waking you up at the end.

This is why it is very important that we know about your general

health before you have an anaesthetic or an operation, so that we
can plan the best way to do it.

Your Guide to Surgery

25
 Phase 1: risk evaluation

The first stage of your Pre-Operative Assessment is called the

“Risk Evaluation”. This is to make sure that it is safe to proceed
with your operation, and to identify any further tests or checks that
are needed. Your surgeon may decide to refer you for Risk
Evaluation before you have decided to have surgery, so that
we can help you make an informed decision.

It can happen in a few ways:

• You may be sent a telephone appointment where a pre-

operative assessment nurse will take you through a
questionnaire. We will also want to know about any regular
medications you are taking.

• In some cases we will send you an appointment to visit us in

hospital. This will be if we anticipate that you will need other
Your pathway to surgery

tests or appointments that mean you will come into hospital

anyway. We will try and keep the number of visits into hospital
to a minimum.

We will also need your height, weight and vital signs (such as
your blood pressure). In most cases, these will be taken when you
visit your surgeon, but if not, we will ask you GP for this. If you
take your height, weight and blood pressure at home, then we can
usually use this, but it is very important that this is accurate as we
may be basing drug doses on these.

Your Guide to Surgery

26
Your nurse assessment

Most people will speak to a pre-assessment nurse specialist, to

discuss any medical problems you may have, how they may
impact your surgery and how surgery may affect them. Most of
this can be done at a telephone consultation, but we may need to
bring you into hospital for an appointment, depending on the
circumstances.

An accurate list of your medicines is very important. We aim to

collect this information directly from your GP practice via a system
known as the NHS Summary Care Record. We need permission
to access your information, and if you do not consent to this, then
it is essential that you provide this information yourself. We will
then advise you which medications to stop, and which ones to
continue taking before surgery.

If you are allergic to anything, this will be recorded. As well as

medications, we need to know about other important allergies
including eggs, nuts, nickel/metal, plasters/ dressings, latex or

Your pathway to surgery

rubber.

Tests will be organised if necessary, depending on the type of

operation and anaesthetic you're having. Tests might include
blood tests and an ECG (heart tracing). We will usually need you
to visit hospital for an ECG, but we can usually arrange for your
local GP or pharmacy to do blood tests.

All this information will build a picture of the risks of you having
your operation.

This is a good time to ask questions and talk about worries that
you may have. If the staff in the clinic cannot answer your
questions, they will help you find someone who can.

Your Guide to Surgery

27
 If you’re High Risk

Or you are having a very major or complex operation that carries

high risks, or if you have other serious medical problems, you
may also need to see an anaesthetist.

If your operation is not urgent, the anaesthetist at the pre-

operative assessment clinic may talk to you about taking some
time to improve your health. More tests may be needed, or some
treatment may need to be started. They would do this working
closely with your surgeon. If your operation is urgent, the
anaesthetist will liaise with the surgeon and the critical care team,
to ensure that your care can be tailored to suit your needs.

It is also possible that the anaesthetist you see thinks there are
very high risks if you have the operation. You may want time to
think about whether to go ahead with the operation.

Referrals to other specialists

Your pathway to surgery

You may also be referred to other specialists to investigate

potential medical problems that might have an impact on your
surgery (such as sleep apnoea or anaemia).

These referrals aim to identify and treat conditions that may cause
a problem with your recovery after the operation, and therefore to
prevent you coming to harm that could have been avoided. We
will only delay your surgery if we feel that this is the case.

Your Guide to Surgery

28
Once we’ve completed your risk
evaluation
We will inform your surgeon, and they will look for a date for your
surgery. If your surgery is urgent, they may already have given
you a provisional date, but this is only confirmed once you’ve
completed your risk evaluation.

Specialty preparation services

For certain operations, you will go on to have assessments and

education specific to that surgery. It may involve:

• Education and counselling from specialist nurses, including

cancer specialists.

• Education for operations where you may have a stoma

• Education from physiotherapists (particularly for hip and knee

Your pathway to surgery

replacements)

• Psychologist input

• Extra blood tests, x-rays or scans to aid in planning for the

operation

• Meetings with research nurses to discuss being involved in

clinical trials

Every operation may have different people involved, and your

surgical team will arrange who you will see. Wherever possible,
we try and do all of these things on the same visit, and if you have
to come to the pre-operative assessment clinic we try and do this
on the same day too.

Your guide to surgery

29
 Phase 2: preparation
Once you have received a date for
your surgery, you will be placed Surgical pathways
onto a surgical pathway. We will we
will usually ask you to isolate
before surgery to protect you from
infection. Information on these
pathways is available on our
website, which you can access by
scanning the QR code opposite
with your mobile phone camera

Or you can type this link into your browser

Https://www.Uhcw.Nhs.Uk/caring-for-you/coronavirus/surgical-
pathways/
Your pathway to surgery

2 to 4 days before your date of

Preparing for your
surgery, you will be asked to come
surgery
to a clinic where blood tests and
screening for infection will take
place, details of this are in the
leaflet called preparing for your
surgery. You should have
received this at your risk
evaluation appointment. If not you
can access it with this QR code.

Or you can type this link into your browser

Https://www.Uhcw.Nhs.Uk/patiets/clinical-support-
services/anaesthetics/

Your guide to surgery

30
Medical conditions and surgery

Many medical conditions can affect recovery from surgery. It is

important to make sure any known conditions are controlled as
well as possible ahead of your surgery.

When you have your pre-operative assessment you will be asked

about your health in order to screen for medical conditions you
may not know you have, but which may have an impact on your
surgery. It is not unusual for new conditions to be discovered in
the run up to surgery, and there is usually time to control them
well enough to prevent them from causing problems during
surgery.

If you are worried that your health has changed since your
preoperative assessment, please get in touch – you will have
been given contact numbers after your assessment.

Your pathway to surgery

Diabetes

Good control of your blood sugar is really important to reduce

your risk of infections after surgery. Think about your diet and
weight. Talk to your diabetes nurse or team early to see if they
need to make any changes to your treatment.

Your preoperative assessment nurse will also advise you on what

to do with your treatment before your surgery.

Your guide to surgery

31
 Blood pressure

Blood pressure should be controlled to safe levels to reduce your

risk of stroke. Sometimes operations may be delayed if it is too
high.

Have your blood pressure checked at your surgery well ahead of

your operation – some GP surgeries have automated machines
so you can pop in any time. If it is high, your GP can check your
medications and make any changes needed ahead of the
operation.

Anaemia (low blood count)

If you have been bleeding or have a chronic medical condition, a

blood test can check whether you are anaemic. We will do a blood
test looking for anaemia before your surgery if it is appropriate. If
you are found to be anaemic, we will automatically refer you to a
specialist clinic which will provide you with the appropriate
Your pathway to surgery

treatment.

Treating your anaemia before surgery reduces the chance of you

needing a blood transfusion. It will also help your recovery and
make you feel less tired after your surgery.

Heart, lung and other medical problems

If you have any other long-term medical problems, consider

asking your GP or nurse for a review of your medications,
especially if you think your health is not as good as it could be.

Your Guide to Surgery

32
Anxiety and mental health

Most people feel some anxiety about having surgery. If the

thought of going into hospital is making you very anxious or upset,
it may be helpful to talk about your concerns with your GP. In
some areas GPs can refer you for specific support.

Many techniques including mindfulness, relaxation and breathing

exercises or yoga could help you relax before and after your
surgery.

If you are taking medication for mental health problems, it is

important to let the preoperative assessment nurse at the hospital
know about your medication. They will usually not want you to
stop this. They can help organise any particular support you need
for your time in hospital or return home.

Dental health

If you have loose teeth or crowns, a visit to the dentist may

Your pathway to surgery

reduce the risk of damage to your teeth during an operation.

Your Guide to Surgery

33
 Deferring your surgery

Occasionally, after assessment we will have to defer your surgery

because you are not yet fit to proceed. This means that
proceeding with surgery may expose you to risks of harm that
could be prevented. It doesn’t necessarily mean your surgery will
be cancelled altogether. Your preoperative assessment nurse or
anaesthetist will explain why you have been deferred and the plan
of what to do next. It may be that further information or tests are
required.

We are always mindful of the urgency of the operation, and

deferring it will be a balance between the risks of waiting and the
risks of proceeding. A consultant anaesthetist will often be
involved in this decision.

The type of operation you are having can also affect these
Your pathway to surgery

decisions, so you may find you are not deferred for one operation,
and then you are deferred for the next.

Your guide to surgery

34
Making plans to go home

You should make arrangements for going home BEFORE you

come into hospital.

It is helpful to find out from your surgeon when they would expect
you to go home. Sometimes this can be difficult to predict, but
having a date to aim for can be helpful.

You must arrange for an adult to drive you home after surgery. A
taxi is not acceptable unless you have a responsible adult to
accompany you. Bring the name and phone number of this person
with you. If you need an ambulance to take you home, this will be
decided by the staff looking after you after surgery, and arranged
for you.

Before you come in, find out:

• Who is going to take you home?

Your pathway to surgery

• What is their phone number?

• Who will be able to help you at home?

• How long can they stay with you?

Your guide to surgery

35
 Planning for your recovery at home
When you are discharged from hospital, we will check that you
are safe to be at home, but this doesn’t mean you will be
completely recovered. You are likely to still need painkillers, and
will find your energy levels will be lower. Nonetheless, you will
probably find you recover quicker in the comfort of your own
home. You will also find you become more active once you are at
home, and this is important for your recovery. After major surgery,
it can take weeks or sometimes months before you feel fully
recovered.
It is worth planning ahead:
• Make sure you have plenty of food that is easy to prepare at
home, or someone who can help you with this
• You may want to ask a friend or relative to help you with
shopping
• Think about things you can do while you’re recovering so you
don’t get bored
Your pathway to surgery

• Have a thermometer at home – so you can check your

temperature in case you feel unwell when you get home
• Make sure you have a supply of simple over-the-counter
painkillers at home

Simple painkillers like paracetamol and ibuprofen can be

very effective, though it is much more expensive for a
hospital to provide them than for you to buy them from a
chemist (they cost as little as 19p). Buying your own supply
before your operation can help us spend money where it is
most needed.

Your Guide to Surgery

36
 Your Anaesthetic
It is common to be anxious about having an anaesthetic,
though it doesn’t need to be. Modern anaesthesia is very
safe, though like everything in medicine, it has small risks.

This section explains in detail about ways the anaesthetic

can be given, including the risks involved, in order to help
you make the right decisions for your care.

Contents Page

Fasting before surgery 38

What is anaesthesia? 40

Local anaesthesia 41

Regional anaesthesia 41

Spinal anaesthesia 42

General anaesthesia 49 Your anaesthetic

Sedation 50

Risks of anaesthesia 51

Your guide to surgery

37
 Fasting before surgery

If you are coming into hospital in the morning

• Do not eat anything after 2am on the night before (please do

not drink milk or fruit juice after this time either)

• Drink as much water, squash, black tea or coffee as you want

until 6am

• At 6am, drink your “pre-op” carbohydrate drink if you have

been given one (not all operations need this)

• You are encouraged to continue to drink water until 7am

If you are coming into hospital in the afternoon

• Do not eat anything after 7am in the morning (please do not

drink milk or fruit juice after this time either)

• Drink as much water, squash, black tea or coffee as you want

until 11am
Your anaesthetic

• At 11am, drink your “pre-op” carbohydrate drink if you have

been given one (not all operations need this)

• You are encouraged to continue to drink water until midday

Your guide to surgery

38
Why is fasting important?

If you are expecting a general anaesthetic, you will need to be

fasted so that your stomach is empty at the time the anaesthetic if
given.

If your stomach is not empty, acid, bile or food may pass back up
your food pipe (oesophagus) and go into your lungs. This is called
aspiration and can be fatal. Aspiration is extremely rare in people
who have followed the fasting instructions correctly.

Even if you are not expecting a general anaesthetic, your

anaesthetist will want you to prepare in the same way. This is
because, if the other anaesthetic technique doesn’t work, or if
there are problems during the surgery, you may then need to be
given a general anaesthetic.

Acid Reflux

If you suffer from acid reflux or severe heartburn you must tell
your anaesthetist. If you are on medications that control these
symptoms, then you should take them as normal. If it is not
treated, the anaesthetist may want to give you a drug to help with
the acid. In severe cases, the way we give the anaesthetic is
modified to ensure that acid does not travel back up the food pipe Your anaesthetic
and enter the lungs

Your Guide to Surgery

39
 What is anaesthesia?

The word anaesthesia means ‘loss of sensation’. It can involve a

simple local anaesthetic injection which numbs a small part of the
body, such as a finger or around a tooth. It can also involve using
powerful drugs which cause unconsciousness. These drugs also
affect the function of the heart, the lungs and the circulation. As a
result, general anaesthesia is only given under the close
supervision of an anaesthetist, who is trained to consider the best
way to give you an effective anaesthetic but also to keep you safe
and well. The drugs used in anaesthesia work by blocking the
signals that pass along your nerves to your brain. When the drugs
wear off, you start to feel normal sensation again.

Types of anaesthesia

There are four main types of anaesthetic which will be discussed

in more detail in this section

• Local anaesthesia

• Regional anaesthesia
Your anaesthetic

• Spinal anaesthesia

• General anaesthesia

There is also sedation, which can be combined with local,

regional or spinal anaesthesia.

Your guide to surgery

40
Local anaesthesia

A local anaesthetic numbs a small part of the body. It is used

when the nerves can be easily reached by drops, sprays,
ointments or injections. You stay conscious, but free from pain.
Common examples of surgery under local anaesthetic are having
teeth removed and some common operations on the eye.

Regional anaesthesia

This is when local anaesthetic is injected near to the nerves

which supply a larger or deeper area of the body. The area of the
body affected becomes numb. This could be used for
• Operations on your hand, arm, or sometimes shoulder

• Operations on your foot or ankle

Your anaesthetic
This can be the best option for your operation, recovery, and pain
control afterwards, but depends on the operation you’re having.
The anaesthetist who will be looking after you will discuss this
with you in more detail if it’s appropriate.

Your guide to surgery

41
 Spinal anaesthesia

For many operations it is usual for patients to have a general

anaesthetic. However, for operations in the lower part of the body,
it is often possible for you to have a spinal anaesthetic instead.
This is when an anaesthetic is injected into your lower back
(between the bones of your spine). This makes the lower part of
the body numb so you do not feel the pain of the operation and
can stay awake.

Typically, a spinal lasts one to two hours, but drugs can be used
which last longer or shorter depending on the operation. Other
drugs may be injected at the same time to help with pain relief for
many hours after the anaesthetic has worn off. During your spinal
anaesthetic you may be:

• Fully awake

• Sedated – with drugs that make you relaxed, but not

unconscious
Your anaesthetic

For some operations a spinal anaesthetic can also be given

before a general anaesthetic to give additional pain relief
afterwards. Your anaesthetist can help you decide which of these
would be best for you.

Your guide to surgery

42
When is spinal anaesthesia used?

Many operations in the lower part of the body are suitable for a
spinal anaesthetic with or without a general anaesthetic.
Depending on your personal health, there may be benefits to you
from having a spinal anaesthetic. Your anaesthetist is there to
discuss this with you and to help you make a decision as to what
suits you best.

A spinal anaesthetic can often be used on its own or with a

general anaesthetic for:

• orthopaedic surgery on joints or bones of the leg

• groin hernia repair, varicose veins, haemorrhoid surgery (piles)

• vascular surgery: operations on the blood vessels in the leg

• gynaecology: prolapse repairs, hysteroscopy and some kinds of

hysterectomy

• urology: prostate surgery, bladder operations, genital surgery.

Your Anaesthetic

Your Guide to Surgery

43
 How is the spinal performed?

1. You may have your spinal in the anaesthetic room or in the

operating theatre. You will meet the anaesthetic assistant who
is part of the team that will look after you.

2. Your anaesthetist will first use a needle to insert a thin plastic

tube (a ‘cannula’) into a vein in your hand or arm. This allows
your anaesthetist to give you fluids and any drugs you may
need.

3. You will be helped into the correct position for the spinal. You
will either sit on the side of the bed with your feet on a low
stool or you will lie on your side, curled up with your knees
tucked up towards your chest.

4. The anaesthetic team will explain what is happening, so that

you are aware of what is taking place.

5. A local anaesthetic is injected first to numb the skin and so

make the spinal injection more comfortable. This will sting for
a few seconds.

6. The anaesthetist will give the spinal injection and you will
need to keep still for this to be done. It involves passing a very
fine needle between the bones of your spine into a space
Your Anaesthetic

close to your spinal cord. It can sometimes be quite difficult.,

but anaesthetists are very experienced at doing this, and it is
quite normal if they need to try a couple of times.

7. A nurse or healthcare assistant will usually support and

reassure you during the injection.

Your Guide to Surgery

44
What will I feel?

A spinal injection is often no more painful than having a blood test

or having a cannula inserted. It may take a few minutes to
perform, but may take longer if you have had any problems with
your back or have obesity.
• During the injection you may feel pins and needles or a sharp
pain in one of your legs – if you do, try to remain still, and tell
your anaesthetist.
• When the injection is finished, you will usually be asked to lie
flat if you have been sitting up. The spinal usually begins to
have an effect within a few minutes.
• To start with, your skin will feel warm, then numb to the touch
and then gradually you will feel your legs becoming heavier and
more difficult to move.
• When the injection is working fully, you will be unable to lift your
legs up or feel any pain in the lower part of the body.

Testing if the spinal has worked

Your anaesthetist will use a range of simple tests to see if the
anaesthetic is working properly, which may include:
• spraying a cold liquid and ask if you can feel it as cold Your Anaesthetic
• brushing a swab or a probe on your skin and asking what you
can feel
• asking you to lift your legs.
It is important to concentrate during these tests so that you and
your anaesthetist can be reassured that the anaesthetic is
working. The anaesthetist will only allow the surgery to begin
when they are satisfied that the anaesthetic is working.

Your Guide to Surgery

45
 During the operation (spinal anaesthetic alone)

• In the operating theatre, a full team of staff will look after you. If
you are awake, they will introduce themselves and try to put
you at ease.

• You will be positioned for the operation. You should tell your
anaesthetist if there is something that will make you more
comfortable, such as an extra pillow or an armrest.

• You may be given oxygen to breathe, through a lightweight,

clear plastic mask, to improve oxygen levels in your blood.

• You will be aware of the ‘hustle and bustle’ of the operating

theatre, but you will be able to relax, with your anaesthetist
looking after you.

• You may be able to listen to music during the operation. You are
welcome to bring your own music, with headphones.

• You can talk with the anaesthetist and anaesthetic practitioner

during the operation.

If you have sedation during the operation, you will be relaxed and
may be sleepy. You may snooze through the operation, or you
may be awake during some or all of it. You may remember some,
none or all of your time in theatre.
Your Anaesthetic

You may still need a general anaesthetic if:

• your anaesthetist cannot perform the spinal

• the spinal does not work well enough around the area of the
surgery

• the surgery is more complicated or takes longer than expected.

Your Guide to Surgery

46
Side effects and complications of spinal anaesthesia

Common (1 in 10 to 1 in 100)

• Low blood pressure – as the spinal takes effect, it can lower

your blood pressure. This can make you feel faint or sick. This
will be controlled by your anaesthetist with the fluids given
through your drip and by giving you drugs to raise your blood
pressure.

• Itching – this can commonly occur if morphine-like drugs have

been used in the spinal anaesthetic. If you have severe itching,
a drug can be given to help.

• Difficulty passing urine (urinary retention) or loss of bladder

control (incontinence) – you may find it difficult to empty your
bladder normally while the spinal is working or, more rarely, you
may have loss of bladder control. Your bladder function will
return to normal after the spinal wears off. You may need to
have a catheter placed in your bladder temporarily, while the
spinal wears off and for a short time afterwards. Your bowel
function is not affected by the spinal.

• Pain during the injection – if you feel pain in places other than
where the needle is – you should immediately tell your
anaesthetist. This might be in your legs or bottom, and might be
due to the needle touching a nerve. The needle will be
Your Anaesthetic
repositioned.

Your Guide to Surgery

47
 Side effects and complications of spinal anaesthesia

Less Common (1 in 100 to 1 in 1000)

• Post-dural puncture headache – there are many causes of

headache after an operation, including being dehydrated, not
eating and anxiety. Most headaches can be treated with simple
pain relief. Uncommonly, after a spinal it is possible to develop
a more severe, persistent headache called a post-dural
puncture headache, for which there is specific treatment. This
happens on average about 1 in 200 spinal injections. This
headache is usually worse if you sit up and is better if you lie
flat. The headache may be accompanied by loss of hearing or
muffling or distortion of hearing.

Rare (1 in 1000 to 1 in 10,000)

• Nerve damage – this is a rare complication of spinal

anaesthesia. Temporary loss of sensation, pins and needles
and sometimes muscle weakness may last for a few days or
even weeks, but most disappear with time and a full recovery is
made.

• Permanent nerve damage is rare (approximately 1 in 50,000

Your Anaesthetic

spinals). It has about the same chance of occurring as major

complications of having a general anaesthetic

Your Guide to Surgery

48
General anaesthesia

General anaesthesia is a state of controlled unconsciousness

during which you feel nothing. You will have no memory of what
happens while you are anaesthetised.

A general anaesthetic is essential for a very wide range of

operations. This includes all major operations on the heart or
lungs or in the abdomen, and most operations on the brain or the
major arteries. It is also normally needed for laparoscopic
(keyhole) operations on the abdomen.

Anaesthetic drugs are injected into a vein, or anaesthetic gases

are given for the patient to breathe. These drugs stop the brain
from responding to sensory messages travelling from nerves in
the body.

Anaesthetic unconsciousness is different from a natural sleep.

You cannot be woken from an anaesthetic until the drugs are
stopped and their effects wear off.

While you are unconscious, the team in theatre look after you with Your anaesthetic
great care.

Your anaesthetist stays near to you all the time.

Your guide to surgery

49
 Sedation

Sedation involves using small amounts of anaesthetic drugs to

produce a ‘sleep-like’ state. It makes you physically and mentally
relaxed, but not unconscious.

Many people having a local or regional anaesthetic do not want to

be awake for surgery. They choose to have sedation as well.

If you have sedation, you may remember little or nothing about

the operation or procedure. However, sedation does not
guarantee that you will have no memory of the operation. Only a
general anaesthetic can do that.

The “deeper” your sedation is (ie. More asleep you appear to be),
the closer it comes to a general anaesthetic. This is why you may
be expected to prepare as if it were a general anaesthetic by
fasting beforehand.
Your Anaesthetic

Combinations
Anaesthetic techniques are often combined. For example, a
regional anaesthetic may be given for pain relief afterwards, and
a general anaesthetic makes sure you remember nothing

Your guide to surgery

50
Risks of anaesthesia

The risks of anaesthesia are significantly smaller than those

of the surgery – the surgeon should explain these to you in
detail before you consent to the surgery.

In modern anaesthesia, serious problems are uncommon.

Risk cannot be removed completely, but modern equipment,

training and drugs have made it a much safer procedure than
people may perceive it to be.

To understand a risk, you must know:

• How likely it is to happen

• How serious it could be

• How it can be treated.

The risk to you as an individual will depend on:

• Whether you have any other illness

• Personal factors, such as smoking or being overweight

Your anaesthetic
• Surgery that is complicated, long or done in an emergency.

More information on the side effects and complications than is

listed here is given in the booklet anaesthesia explained which is
available from the college website via the link below:

Www.Rcoa.Ac.Uk/document-store/anaesthesia-explained

Your guide to surgery

51
 Risks of anaesthesia

Very common and common side effects

1 in 10 (someone in your family to 1 in 100 people (someone in a
street)
RA = having a regional or spinal anaesthetic
GA = having a general anaesthetic

GA RA
Feeling sick and vomiting after surgery ✓ ✓

Sore throat ✓ 

Dizziness, blurred vision ✓ ✓

Headache ✓ ✓

Bladder problems (eg. Difficulty passing urine) ✓ ✓

Damage to the lips or tongue (usually minor) ✓ 

Your Anaesthetic

Itching ✓ ✓

Aches, pains and backache ✓ ✓

Pain during injection of drugs ✓ ✓

Bruising and soreness ✓ ✓

Confusion or memory loss ✓ 

Your guide to surgery

52
Uncommon side effects and complications
1 in 1000 (someone in a village)

GA RA

Chest infection ✓ 
Damage to the cornea of the eye ✓ 
Damage to teeth ✓ 
An existing medical condition getting worse ✓ ✓
Nerve damage to peripheral nerves ✓ ✓
Awareness (becoming conscious during your
operation)
✓ 

Rare or very rare complications

1 in 10,000 (someone in a small town) to 1 in 100,000 (someone
in a large town)

GA RA
Damage to the eyes including loss of vision ✓ 
Your anaesthetic
Heart attack or stroke ✓ ✓
Serious allergy to drugs ✓ ✓
Nerve damage to nerves in the spine ✓ ✓
Death (probably about 5 for every million
anaesthetics in the UK)
✓ ✓
Equipment failure causing significant harm ✓ ✓
Your Guide to Surgery
53
 Managing your pain

There are many effective treatments to help keep you

comfortable after your operation. The different ways of
relieving pain vary depending on the operation you have,
and on particular aspects of your medical history that have
been identified during your pre-operative assessment. The
options for pain control will be explained before your
operation by the anaesthetist looking after you.

Contents Page

Post-operative pain 56

The pain service 57

Types of pain relief

Tablets, liquids and suppositories 58

Managing your pain

Injections 58

Patient controlled analgesia 60

(PCA)

Wound catheters 61

Nerve blocks 61

Spinal (intrathecal) analgesia 62

Epidurals 62

Managing pain when you go home 69

Your guide to surgery

55
 Post-operative pain

What is pain?

Pain is the unpleasant sensation that people experience after an

injury or surgery. You will be asked to tell the doctors and nurses
about any pain that you have. They will ask you about the severity
of the pain at rest and on movement, such as deep breathing,
coughing or sitting out of bed.

Why treating pain is important

It may seem obvious, but good pain relief (also called “analgesia”)
is very important to your recovery and has many benefits, such as

• Greater comfort while you recover from surgery, meaning you

are in a more positive mind-frame

• Quicker recovery as breathing exercises, mobilising and

physiotherapy can all be managed with less discomfort
Managing your pain

• Reduces the complications of surgery such as chest infections

and blood clots

Your guide to surgery

56
The pain service

At the university hospitals coventry and warwickshire NHS trust

we aim to provide the safest and best pain relief for all patients
after surgery. To achieve this, we have an acute pain service
provided by a team of specialist nurses. The team is available
weekdays to advise and answer any questions that you may
have about pain relief. If you would like to speak to one of the
team you can ask the ward nurses to contact us.

How will my pain be treated?

There are many different ways to control pain and sometimes
combinations of treatments are used to get the best results. The
effectiveness of your pain relief will be assessed at regular
intervals and adjustments to the treatment can be made if
required. We aim for patients to be able to cough, breathe deeply
and move around the ward without experiencing significant
discomfort. It is much easier to relieve pain if it is managed
before it gets too severe.

Managing your pain

The ways we can manage pain are:
• Tablets, liquids and suppositories
• Injections of painkiller
• Patient controlled analgesia (PCA)
• Wound catheters
• Nerve blocks
• Spinal analgesia
• Epidural analgesia

Your guide to surgery

57
 Tablets, liquids and
suppositories
If you are able to eat and drink, the most convenient way to take
painkillers is by mouth. We know that combinations of different
types of analgesics (painkillers) provide the best pain relief.

If you find swallowing tablets difficult you need to tell the nurses
and doctors looking after you, as soluble or liquid forms are
available. Some patients may be offered the use of pain killers in
the form of suppositories.

Paracetamol is prescribed for nearly all patients to take regularly

after surgery as research has shown that it can improve the
effectiveness of other painkillers. Smaller doses of stronger
painkillers can then be used with reduced side effects.

You may be given some painkillers to take home with you.

Managing your pain

Injections
When patients are experiencing a lot of discomfort, an injection of
strong painkiller can be given either just under the skin
(subcutaneous) into a muscle (intramuscular) or a vein
(intravenous).
These can be given at regular intervals or as required.
Sometimes a small plastic tube (a cannula; also called a venflon
or a “drip”) will be inserted into the vein which will prevent the
need for several injections.

Your guide to surgery

58
Opioids
Drugs such as morphine are known as opioids. They are widely
used and effective for short term pain management. As with all
drugs, morphine can produce some unwanted side effects, the
more common of which are:

• Tiredness/ drowsiness

• Light-headed feeling

• Vivid dreams

• Itchiness

• Nausea, vomiting

• Constipation

Treatments are readily available to treat any unpleasant side

effects, so it is very important for you to report any symptoms.

Patients sometimes worry about becoming addicted to opioids like

morphine. It is important to stop taking them once the pain has
improved, and to stop them if they don’t improve the pain, but

Managing your pain

when used to treat pain after surgery they do not cause addiction.

The Faculty of Pain Medicine

produces a range of leaflets
which have more information

https://www.fpm.ac.uk/opioids-
aware/information-patients

Your guide to surgery

59
 Patient controlled analgesia
(PCA)
PCA is a system that allows you to be in control of your own pain
relief. A device containing a strong painkiller such as morphine is
connected to a cannula in the vein, usually in your hand or arm.
The device enables you to control the pain via a button on the
PCA handset.

When you press the button a small dose of painkiller is delivered

into the vein.

• Pca allows you to give yourself small amounts of the pain killing
drug when you require it and avoids any wait to get analgesia
and also any further injections.

• You can press the button as often as you require. It is important

not to let the pain build up before pressing the button.

• The device has a safety mechanism to make sure that you

cannot give yourself too much painkiller. It will only allow a
measured dose to be delivered every 5 minutes.
Managing your pain

• Pca is very safe as long as only you press the button, as only
you know the pain you can feel and how much painkiller you
need to relieve it and how much effect the medicine is having.
The nurses will check and record at regular intervals how much
of the painkiller you are using.

• If you are using the pca and continue to experience pain, you
must tell the nurse looking after you.

You can have a pca until you are able to take medicines by
mouth.

Your guide to surgery

60
Wound catheters

Local anaesthetic is administered into your wound via one or

more small plastic tubes. This should give a numb area around
the wound. The surgeon places the tubes during the operation.
They are connected to a pump that continuously delivers local
anaesthetic. Wound catheters can stay in for several days after
your operation, but can only be used for certain types of
procedure and will usually need other forms of pain relief as well.

Nerve blocks
A nerve block is when the nerve supply to an area that is being
operated on is anaesthetised with local anaesthetic solution. This
will normally make the area or limb being operated on feel weak

Managing your pain

and numb. Nerve blocks normally last for approximately 12 hours
after surgery and some patients may also have a continuous
infusion of local anaesthetic via a small pump. In addition to the
nerve block patients will also be prescribed additional painkilling
medicine.
Your anaesthetist will explain nerve block procedure to you.
With all nerve blocks there is a very rare chance of nerve
damage, but modern techniques make the risk of this extremely
low and the pain relief they provide is very good.

Your guide to surgery

61
 Spinal (intrathecal) analgesia

Spinal analgesia is administered in a spinal injection (see the

section on spinal anaesthesia) and can either be given with a
spinal anaesthetic as your only anaesthetic, or can be given with
a general anaesthetic.

Spinal analgesia is usually a very small dose of opioid such as

morphine. When given as a spinal injection, it can be much more
effective than when injected into a vein, and will last a lot longer
(often between 12 and 24 hours).

Epidural analgesia
An epidural is a fine, flexible tube placed in the back near the
nerves coming from the spinal cord, through which pain-killing
drugs can be given to give pain relief.
It is used during surgery (usually in addition to a general
Managing your pain

anaesthetic), after the operation for pain control, or both.

Local anaesthetic, and sometimes other pain-relieving drugs, are
put through the epidural catheter. This lies close to the nerves in
your back. As a result, the nerve messages are blocked. This
gives you pain relief, which varies in extent according to the
amount and type of drug given. The local anaesthetic may cause
some numbness and weakness as well as pain relief.
An epidural pump is used to give pain-relieving drugs
continuously through the epidural catheter. The pain relief lasts
as long as the pump is running. When it is stopped, full feeling
will return within a few hours.

Your guide to surgery

62
Why have an epidural?
Epidurals are commonly used for pain relief after major surgery
where there will be large cuts in the thorax (chest), abdomen
(tummy) or pelvis.

What are the benefits of an epidural?

If your epidural is working well, after your surgery you will have
better pain relief than with other methods, particularly when you
take a deep breath, cough or move about in the bed.

You should need less alternative strong pain relief medicine. This
means your breathing will be better, there should be less nausea
and vomiting, and you are likely to be more alert.

There is some evidence that other complications of surgery may

be reduced, including reduced risk of blood clots in the legs or
lung and chest infection. There is also some evidence that you
may lose less blood with an epidural, which would reduce your
chance of needing a blood transfusion.

Managing your pain

Your guide to surgery

63
 What if I don’t have an epidural?

It is your choice. Your anaesthetist will tell you if they particularly

recommend an epidural, and what alternatives there may be.

Other pain relief may be less effective and may have more side
effects including nausea and constipation., and in some people,
confusion.

It is often possible to combine other options such patient

controlled analgesia (PCA) and methods such as spinal analgesia
or nerve blocks as an alternative.

Can anyone have an epidural?

No. An epidural is not possible for some people. Your anaesthetist

will discuss this with you if necessary. An epidural may not be
possible for you if:

• you take blood-thinning drugs, such as warfarin

• your blood does not clot properly

• you are allergic to local anaesthetic

Managing your pain

• you have significant deformity of the spine

• you have an infection in your back

• you have had previous surgery on the spine with metalwork in

your back

• you have had problems with a spinal anaesthetic or epidural in

the past.

Your Guide to Surgery

64
How is an epidural done?
Epidurals can be put in when you are fully awake, or with sedation
(drugs that make you sleepy and relaxed).
Your anaesthetist will talk to you about which might be best for
you. The steps for having an epidural are:
1. a cannula (drip) is placed in a vein in your arm for giving fluid
2. you will be asked to sit up or lie on your side. You will be
helped to bend forwards, curving your back as much as you
can
3. the anaesthetist will clean your back with antiseptic
4. a small injection of local anaesthetic is given to numb the skin
5. a needle is used to place a thin plastic catheter (tube) into the
epidural space in your back. The needle is removed, leaving
only the catheter in your back.

How will this feel?

The local anaesthetic injection in the skin will sting briefly. There
will then be the feeling of pushing, but usually no more than
discomfort as the needle and catheter is inserted.
Occasionally, a sharp feeling, like an electric shock, is felt. If this
happens, it will be obvious to your anaesthetist. They may ask

Managing your pain

you where you felt it.
A sensation of warmth and numbness gradually develops after the
epidural is started. For some types of epidural, your legs may feel
heavy and become difficult to move.
Overall, most people do not find these sensations to be
unpleasant, just a bit strange.

Your Guide to Surgery

65
 Risks of having an epidural
The risk of complications should be balanced against the benefits
and compared with alternative methods of pain relief. Your
anaesthetist can give you more information and help you
understand the relative risks.

Very common side effects (occur in around 1 in 10)

• Low blood pressure – it is normal for the blood pressure to fall a

little when you have an epidural. Your anaesthetist will use
fluids and drugs to correct it.

• Inability to pass urine – the nerves to the bladder are affected

by the epidural. A catheter (tube) is inserted into the bladder to
drain away the urine. This is often needed after major surgery
with or without an epidural.

• Itching – this is a side effect of the pain relief drugs that are
sometimes used in an epidural. Antihistamine drugs may help,
or the drug in the epidural can be changed.

• Feeling sick – this is less common with an epidural than with

Managing your pain

other pain relief methods. It may be helped by anti-sickness

medicines.

• Inadequate pain relief – the epidural may not relieve all your
pain. Your anaesthetist or the pain relief nurses looking after
you will decide if it can be improved or if you need to switch to
another pain relief method.

Your Guide to Surgery

66
Common side effects (occur in around 1 in 100)

• Headache – headaches are quite common after surgery. It is

possible to get a more severe, persistent headache after having
an epidural. This happens on average about once in every
hundred epidurals. It happens if the needle used to place the
epidural or the epidural catheter unintentionally puncture the
bag of fluid that bathes the spinal cord. A small amount of fluid
leaks out, causing a headache. It can cause a severe headache
that is worse if you sit up and is relieved by lying flat. The
headache sometimes will go away on its own with good
hydration and pain relief. The staff looking after you should alert
the anaesthetic team as this will need to be reviewed by them
before you are discharged. If the headache is severe or
remains, you may need specific treatment for the headache.
The headache may be accompanied by loss of hearing or
muffling or distortion of hearing.

Uncommon side effects (occur in around 1 in 1000)

• Slow breathing – some drugs used in the epidural can cause

Managing your pain

slow breathing or drowsiness, which requires treatment.

• Temporary nerve damage – uncommonly, the needle or

epidural catheter can damage nerves. This can give loss of
feeling or movement in a large or small area of the lower body.
In most people this gets better after a few days, weeks or
months.

Your Guide to Surgery

67
 Rare/very rare complications (less than 1 in 10,000)

• Permanent nerve damage – Permanent nerve damage by the

needle or the catheter is rare:
• permanent harm occurs in 1 in 23,500 to 50,500 spinal or
epidural injections
• Paraplegia or death occurs in 1 in 54,500 to 1 in 141,500
spinal or epidural injections (141,500 is about a third of the
entire population of Coventry in 2020)

• Catheter infection – an infection can occasionally develop

around the epidural catheter. If this happens, it will be removed.
It is rare for the infection to spread deeper than the skin.
Antibiotics may be necessary or, rarely, emergency back
surgery. Disabling nerve damage due to an epidural abscess is
very rare.
Managing your pain

Your Guide to Surgery

68
Managing pain when you go
home
It is normal to have some pain around the wound after your return
home, how much pain will vary with each individual patient.

When you are ready to be discharged from hospital, the ward

doctors will write a prescription for painkillers along with other
medicines that they want you to continue at home.

You should take the painkillers as prescribed and at the

prescribed intervals. If you are not sure about how or when to take
painkillers please ask the ward nurses before you are discharged.
The pain should improve with time and the painkillers can then be
discontinued.

Once you have been discharged from hospital, if you have any
problems with pain, you should contact your gp.

Simple painkillers like paracetamol and ibuprofen can be

very effective, though it is much more expensive for a
hospital to provide them than for you to buy them from a

Managing your pain

chemist (they cost as little as 19p). Buying your own supply
before your operation can help us spend money where it is
most needed.

Your guide to surgery

69
 After the operation
It is natural to be anxious about having an operation, but this often
leads to people worrying about the event of the surgery, and
thinking less about the time after it. In fact, it is very rare to suffer
serious harm or die during an operation – the operating theatre is
probably one of the safest places you can be. The risks are
usually after the operation.

Emerging evidence tells us that alongside adequate preparation,

motivation to recover can have a tangible impact on the success
of your recovery after surgery. This chapter deals with some of the
things you can expect to happen after surgery, and what you can
do to make your recovery as smooth as possible.

Contents Page

Recovering from the anaesthetic 72

What is it like in PACU? 73

Surgical Wards and Enhanced Care units 74

Critical Care 75 After the operation

Physiotherapy after surgery 79

Complications you should know about: 82

Sepsis

Complications you should know about: 85

Blood clots

Your Guide to Surgery

71
 Recovering from the anaesthetic

Where will I be?

After most anaesthetics you will be cared for in a Post-
Anaesthesia Care Unit (PACU), often referred to as “Recovery”.
This is close to the operating theatre. Your surgeon or
anaesthetist can quickly be told about any change in your
condition.

Who will be looking after me?

Staff in PACU will either be nurses or ODPs. They are trained to
deal with critical situations that can happen after surgery, such as
bleeding or low blood pressure. They will also treat any pain or
sickness that you have. Most people receive extra oxygen in the
recovery room, through a face mask or through little tubes that sit
under the nostrils.
If you gave dentures, hearing aids or glasses to staff, they will be
returned to you.
After the operation

How long will I be in PACU?

You will leave PACU when the staff are satisfied that you are
safely recovering normally. This means that you will be awake
enough to communicate, have satisfactory and stable vital signs,
and have any symptoms such as pain and nausea under control.
You will be able to eat or drink according to the instructions of the
surgeon.

Your Guide to Surgery

72
What is it like in PACU?

You will still have the monitors that were attached to you before
your anaesthetic was given. You will also have the cannula in your
hand or arm that was put in. You may also have other cannulas
attached to you.

You may find that we have placed a soft plastic tube (called a
catheter) into your bladder. This allows us to measure how well
your body is producing urine. At first it may give you the sensation
that you need to pass urine and might seem quite distressing.
This is a normal sensation with a catheter, and you will get used
to it. All your urine will be collected by the catheter and you won’t
need to move. The catheter will be taken out after a day or two
once your doctors and nurses are happy that you are making
enough urine and that you can get to the toilet yourself if needed.

Depending on your operation, you may also find you have other
tubes coming from you called surgical drains. They are there to

After the operation

collect any fluid or blood that may collect in the area of your
operation. Your surgeon will warn you if these are likely, and will
remove them as soon as it is safe.

Your Guide to Surgery

73
 Surgical wards

The majority of patients will go to the wards after their operations.

Here you can expect to
• Have regular monitoring of your vital signs to ensure you are
recovering well
• Have symptoms such as pain and nausea addressed
• Have physiotherapy, and input from occupational therapists if
needed
• Have help to wash and dress yourself while you are unable to
do so on your own
Many wards are tailored to certain types of surgery, so the nurses
will have special expertise in managing your care.

Enhanced care units

If you have a particular type of surgery, you may go to a

After the operation

specialist area known as an “Enhanced Care Unit” or ECU, or a

“Step-Down” area. These are areas which have more nursing
staff and more monitoring. They can also manage more specialist
interventions. Often people who have had major surgery will go
here.

Your Guide to Surgery

74
Critical care

After some major operations, or if you have particular health

problems, you may need care in an area that provides a range of
advanced facilities

These advanced facilities are called Critical Care. They are

commonly divided into different types

• Intensive Care Unit (ICU) – This is very specialised care for the
sickest people. People here are usually kept under anaesthetic
and have their breathing supported with a mechanical ventilator,
alongside everything that can be done in HDU.
• High Dependency Unit (HDU) – This is similar to ICU, except
people are awake. They still receive very close monitoring and
often have infusions of drugs to support their heart and blood
pressure. Sometimes special masks will be needed to support
their breathing while still awake.
• Overnight Intensive Recovery (OIR) – this is a limited form of

After the operation

HDU care designed specifically for people after certain types of
surgery.

Your Guide to Surgery

75
 Why might I need to go to Critical Care?
Most people will be sent to these areas for closer monitoring and
so that, should any problems occur, you can be managed by
expert nurses and doctors as swiftly as possible. Occasionally
plans will change during the day, or during your operation, if
things do not go as expected. This is usually done as a
precaution. If this happens the reasons will be explained to you as
soon as possible.

Very occasionally, it is necessary to continue the anaesthetic after

the operation has finished for a few hours, or until your condition
is stable. If you need this type of care, you will not go to the
recovery area. Your anaesthetist will take you to the ICU. When
your condition allows, the ICU team will allow you to breathe for
yourself and you will gradually wake up.

You may have your own nurse, or one nurse looks after two
patients. He/she will ensure that you are comfortable, and give
prescribed medicines to control sickness and prevent blood clots.
Some of the medicines that you were taking at home may be
stopped or changed to help your recovery. If you are worried
After the operation

about this, speak to your nurse.

Your Guide to Surgery

76
What will Critical Care be like?
While you’re in critical care, you can expect:
• Your heart rate, blood pressure, and breathing to be monitored
in a similar way as when you had your anaesthetic
• A special tube may have been inserted into your wrist or arm
during your anaesthetic to monitor your blood pressure – called
an arterial line. This will stay in so we can monitor you closely
and take blood samples
• Another tube may have been inserted into a vein in your neck,
like a very large cannula, so we can deliver drugs closer to your
heart. You may need these special drugs to keep you well after
surgery, and will need close monitoring for as long as you need
them,
• You will probably have a catheter in your bladder to drain urine.
This may be uncomfortably at first, but you’ll get used to the
sensation.
• As your recovery progresses, you will need less monitoring, and
some of your drips, tubes and monitors will be removed.
• The nurses and physiotherapists will teach you regular
breathing exercises. It is very important that you can breathe
deeply and cough effectively throughout your time on ICU or
HDU. This will help avoid a chest infection.
• Your nurse will be able to advise you on visiting times and the
number of visitors allowed.

After the operation

• You may be looked after in an area where there are other
patients who are very ill, and it can sometime get very noisy.
Many monitors will make alarms to alert the nurses of changes,
but aren’t anything to worry about.

When the team looking after you are satisfied that you are
recovering safely, you will return to the surgical ward. The length
of time that you spend in critical care will depend on what type of
operation you have had, any complications, and any other health
problems you may have.

Your Guide to Surgery

77
 What will it be like around me?
You should be prepared to expect a high level of activity in these
areas. Noise levels are likely to be higher than on a general
hospital ward due to the equipment. If you do hear an alarm it
does not necessarily mean that something is wrong, it may mean
there is a change the staff need to be aware of. Staff will be able
to explain the equipment and noises to you should you have
concerns about the alarms. Try not to focus too much on all the
machinery.

You may also find that patients on these units have a range of
serious conditions, many of them not related to surgery. Many
patients in Critical Care will be there because they have life-
threatening illnesses or have been involved in a serious accident,
and you may see people in induced comas while they are being
looked after.

Though you will have a nurse assigned to you, you may find they
will also have to help other patients who are sicker and need
more attention.
After the operation

Your Guide to Surgery

78
Physiotherapy after surgery

Physiotherapy techniques are vital part of your recovery. This

section contains some simple ways that you can help yourself
following your surgery.

After an operation there are risks that may mean you produce
phlegm and be more ‘chesty’ than normal. This can be due to the
anaesthetic, pain from the incision and reduced activity following
an operation.
If phlegm remains in the lungs, it provides an ideal environment
for bacteria to grow and chest infections to develop. A chest
infection can prolong and complicate your hospital stay.
Fortunately, there are a number of simple exercises and
measures that you can take to help reduce the risk of this. The
following advice is to help you to keep your chest clear.

Positioning yourself in bed

When you are in bed ensure you are always in a good position.

After the operation

This means sitting upright or lying on each side alternately. Do not
slump in bed.

Your Guide to Surgery

79
 Walking
The most important thing after your operation is to get out of bed
and walk as soon as possible. This is the most effective way to
prevent a chest infection.
The nurses will help you to sit out in a chair and walk on the ward
as soon as your condition allows. This may be the same day as
your operation but is often the first day after your operation. It is
normal to have oxygen, drips and drains attached but this should
not stop you getting out of bed.
Staff will continue to help you every day until you can do it by
yourself. Once you can walk safely on your own you are expected
to gradually increase the distance you can walk daily. Aim to sit
out at regular intervals and complete regular short walks
throughout the day.

Breathing exercises and coughing

It is essential you do hourly deep breathing and coughing practice
throughout the day.
Deep breathing and coughing may feel uncomfortable, but you
will not cause any damage to stitches or clips. It is very important
that you can cough strongly and effectively after your operation.
After the operation

To help strengthen your cough and ease any pain, support your
wound with a clean rolled towel over the top of your clothing.
Repeat the breathing exercises and coughing for the first few
days following your operation. They may be discontinued when
you are able to walk a moderate distance on the ward, for
example to the bathroom, so long as you are not coughing up any
phlegm.

Your Guide to Surgery

80
Breathing exercises

You must do these exercises every hour in the day when awake
or as advised after your surgery:

Sit upright in bed or preferably in an armchair

1

Take a deep breathe in, preferably through your nose, hold for 5
seconds and breathe out gently through your mouth.
2

Repeat 6 times
3

Support your wound with a rolled towel

4

Cough strongly from your stomach not your throat

5

You may or may not cough up some phlegm

After the operation
6

If you cough up some phlegm spit it into a pot or tissue and repeat
the cycle until you are not coughing up phlegm
7

Rest and repeat the breathing exercises every hour

8

Your Guide to Surgery

81
 Complications you should know
about: sepsis
What is Sepsis?
Sepsis is the body’s reaction to an infection which causes
damage to the tissues and the organs, such as the kidneys, to
fail. It has previously been known as septicaemia or blood
poisoning.

Sepsis can be caused by any type of infection in the body, such

as a chest infection which causes pneumonia, a urine infection,
an infected cut or bite, an infection in a cannula, or a wound
following surgery. In some people, Sepsis can be quite mild where
antibiotics given into the vein are the only required treatment,
although in others, it can become more severe requiring
advanced treatment in an Intensive Care Unit.

Why might I get Sepsis?

Everybody is at risk of developing Sepsis however some people
are more at risk than others. Those more at risk include:
• Those who are having or who have recently had treatment for
cancer;
After the operation

• Are diabetic;
• Are pregnant or have just given birth;
• Have recently had an operation;
• Take long-term steroids;
• Have a wound, cut or bite;
• Are very young or very old;
• Are immunosuppressed for any other reason (the body has
difficulty fighting an infection).

Your Guide to Surgery

82
What does Sepsis do to your body?
Initially, you may feel like you are developing flu like illness. You
may also have some or all of the following symptoms;
• Feel very cold and shivery;
• Feel very hot and looked flushed;
• Have a high temperature;
• Aching muscles;
• Feel very tired;
• Sickness and diarrhoea;
• Low appetite;
• Seem confused, drunk or have slurred speech.

What is the treatment for Sepsis?

The main treatment for Sepsis, no matter how severe, is
antibiotics given into the vein. Ideally, these must be given within
the first hour of diagnosis. Other treatments include fluids given
via a drip if Sepsis has made your blood pressure become
unusually low.

You may also be given oxygen if Sepsis is making it difficult for

you to get oxygen into your blood. You will also have had blood
taken to determine which type of antibiotics would be best for the
infection that you have and to determine if your organs have After the operation
begun to fail. Medical staff will also keep a close eye on how
much urine you are passing, which may mean that a catheter may
have been inserted into your bladder in order to do this.

Your Guide to Surgery

83
 How might I feel after Sepsis?
Following Sepsis, some patients may develop Post-Sepsis
Syndrome. This is a collection of symptoms that can occur for up
to two years following their illness. The severity of their illness and
the length of time spent in hospital can affect this.

Symptoms include the following physical, emotional and

psychological feelings:
• Extreme tiredness;
• Muscle weakness and poor mobility;
• Breathlessness;
• Anxiety, depression and insomnia;
• Poor concentration;
• Hair loss;
• Repeated infections;
• Swollen limbs and joints.

Sepsis Support Group

Sepsis Support groups are held across the country for those who
have had a personal experience with and/or know of a friend or
family member who has experienced Sepsis. For further details
After the operation

about a support group in your area please contact the UK Sepsis

Trust:
Tel: 0800 389 6255
Email: [email protected]
Web: https://sepsistrust.org/get-support/my-local-group/

Your Guide to Surgery

84
Complications you should know
about: blood clots
How to reduce your risk of blood clots during your hospital
stay
We often hear about the risk of Deep Venous Thrombosis (DVT)
or Pulmonary Embolus (PE) while on long distance trips, but they
are more common after admission to hospital.
This leaflet explains how to reduce your risk. If you have any
questions please ask.

What is a deep vein

thrombosis (DVT)?
A DVT is a blood clot
that forms in the deep
veins of the leg. It can
result in a red, painful
swollen leg

After the operation

Your Guide to Surgery

85
 How serious is this condition?
Symptoms generally ease over time for most people with
treatment. However it can be more serious if either of the
following complications arise:
• Swollen and painful leg - known as post-thrombotic syndrome
• Pulmonary Embolus (PE)

What is a Pulmonary Embolus (PE)?

If the blood clot in the leg breaks off, it can travel around the body
and may cause a blockage in a blood vessel going to a lung (PE).
Depending on the size of the blockage, symptoms include chest
pain, shortness of breath and coughing up blood and in the most
severe cases can result in death.

How will I know if I have a DVT or a PE?

There are important signs that can help detect blood clots Please
tell your doctor or nurse if you develop any of the following while
you are in hospital or in the 3 months after discharge:
• DVT signs and symptoms: usually only one leg is affected
which becomes painful, swollen, hot and discoloured affecting
either the whole leg or below the knee. Occasionally the leg
After the operation

veins become swollen and tender, with numbness or tingling on

the overlying skin.
• PE signs and symptoms: new breathlessness without another
apparent cause (e.g. chest infection), pain in the chest, back or
ribs which is worse on breathing in deeply, coughing up blood.

Your Guide to Surgery

86
We have specialised services for these conditions available in the
hospital to ensure you can be diagnosed and treatment started as
quickly as possible if we suspect you have a clot.

Who is at risk?
There are many factors that increase your chance of DVT or PE
including:
• Age over 60 years – the older you are the higher the risk;
• Acute medical illness (e.g. heart or lung disease, kidney
disease, inflammation such as inflammatory bowel disease);
• Major surgery including hip or knee replacement;
• Immobility caused by major trauma, leg injuries, paralysis etc.;
• Personal or family history of DVT or PE;
• Active cancer;
• Obesity;
• Pregnancy and recent delivery;
• Contraceptive pill or some forms of Hormone Replacement
Therapy (HRT);
• If you have a condition which causes a clot more easily.

What precautions will the hospital take to reduce my risk?

When you are admitted to hospital you will undergo an
assessment designed to assess your risk of developing a clot. After the operation
Depending on the outcome of this, a number of measures will be
taken to reduce your risk. This includes making sure you are not
dehydrated and encouraging you to get out of bed as soon as
possible. Inpatients admitted for a planned operation who are on
the oral contraceptive pill may be advised to stop taking it for four
weeks before admission.

Your Guide to Surgery

87
 If you are at higher risk
For those at higher risk, additional methods include:
• Giving a daily injection of a blood thinner (heparin) during your
stay, to be continued after discharge for certain patients (your
team will indicate if this is required and if so for how long). The
main side effect of this is bruising. If you experience any other
adverse effects e.g. bleeding, it is important to tell your doctor
or nurse (if discharged please contact the VTE Nurse Specialist
(see below) during routine hours) or if this is severe contact
your GP or nearest Accident & Emergency Department. Please
be aware that this medication is derived from pigs.
• Tight stockings called Graduated Compression Stockings (or
Antiembolism stockings) or occasionally pumps which squeeze
the legs intermittently.

It is important that both of these are continued for the total

recommended time to ensure full benefit. If after discharge you
have any concerns or queries the VTE Nurse Specialist can be
contacted through the hospital switchboard.

If your risk is felt to be low it will not be necessary to start these

After the operation

treatments unless your condition changes. Once discharged from

hospital the risk of having clots slowly falls. If you develop any of
the symptoms described you should contact either your GP or go
to your nearest Accident & Emergency Department.

Your Guide to Surgery

88
How are DVT and PE treated?
DVT and PE are usually treated with high doses of blood thinning
medications. Standard therapy includes daily heparin injections
given until blood thinning with warfarin tablets has been achieved
(average 5-6 days), or a newer oral anticoagulant taken once or
twice daily. Patients are then referred to the anticoagulation clinic
for regular checks, if you are on warfarin, or for counselling if you
are on a newer oral anticoagulant. You may be prescribed
compression stockings to reduce leg swelling.

After the operation

Your Guide to Surgery

89