Let’s get to know a few important facts about recovery after surgery & anaesthesia procedures.
The recovery can be divided into immediate post-op recovery period where the patient is observed in the post-operative anaesthesia care unit for 2-3 hours and then shifted to the ward. They should fulfil the criteria for safe ward transfer. This is followed by the time at the hospital till discharge. Then, the recovery process at home for normal routine.
The recovery path depends on the surgical procedure and type of anaesthesia. If the patient has undergone a major and prolonged anaesthesia procedure, he/she will be moved to the intensive unit care observation and the recovery protocol and goals differ from the routine.
This article will brief you on minor surgeries, day-care procedures and post anaesthesia recovery.
Main concerns which we need the patient & family to be aware of – hydration, mobilization, pain relief and infection control. Hydration which accounts to intake and output - intake includes water and food which gives you the energy to get into active routine and the output is urine and opening the bowel.
When Can Patients Start Their Oral Intake?
After three hours in PACU (spinal and general anaesthesia), the patient is given clear water and then thick liquids like milk and juice. This is then escalated to semi solids and gradually to solids in the ward once the patient is comfortable. In case of nausea, vomiting or retching, the intravenous fluids are continued till the patient can take adequate food orally.
The patient can start oral intake immediately if the procedure was done under local anaesthesia or nerve block. If intravenous sedation was given, we wait till the patient is completely awake and obeying commands. Even in children, the same applies; once they are wide awake and alert, they are good to resume orals.
We encourage the patients to take plenty of fluids, minimum of 1.5-2 litres per day in any form - water, juices, tender coconut water, porridge, etc. Oily food and spicy food are to be avoided in the first few days so that digestion is not troubled. High fat content foods such as meat, fried foods, etc. take a longer time to digest. It’s better to keep them away as much as possible. Our dietician will guide the patient about a well-balanced nutritious diet.
How Fast Can They Be Mobilized?
For post general anaesthesia (less than two hours of anaesthesia) and intravenous sedation, when the patient is alert and awake, he/she is made to walk to the washroom in PACU which is also one of the discharge criteria for a day-care patient.
Physiotherapist will guide the patients to get back on their feet if there is difficulty in moving. Post orthopaedic, major spine and transplant surgeries, patients require physiotherapist assistance for mobilization.
If the patient has been advised to rest in bed due to surgical concerns, the best way to keep the lungs active is incentive spirometry which helps to stay active. The device looks like a simple task, but it takes a lot of effort to blow out those spirometry balls. Passive limb movements in the bed in periodical repetitions to avoid fluid accumulation in hands and legs should also be done.
In the case of regional anaesthesia i.e., spinal anaesthesia, lower limb nerve blocks – they need to wait 16-24 hours to get mobilized, for the motor blockade effect of anaesthesia to wear off.
Epidural analgesia – patients can walk with epidural catheter if there is no motor weakness.
Pre-operative check list
Postoperative care to restart orals in recovery
When the patient has instructions to walk, he/she can get out of bed and be normal. Do get on your feet as early as possible to avoid complications such as embolism – blood clots formed due to the pooling of blood in veins. This embolism can form anywhere in the blood vessels and lead to serious complications such as heart attack, stroke and limb ischemia. While lying down in bed for a few days, the lungs won’t be functioning completely. The basal part of the lungs goes for rest; this leads to decreased lung function which results in basal collapse. When the patient tries to walk, he may have exertional breathing difficulty due to basal lung collapse. This is mostly seen in elderly, obese patients. They become more susceptible for respiratory infections due to the stasis of secretions.
Pain is an unavoidable factor during the post-surgical period. It is subjective as pain tolerance differs from person to person. The patient can feel pain due to position and prolonged hours of surgery more than at the surgical site pain. Luckily, we have advanced to provide analgesia (pain relief) through a patient-controlled analgesia pump wherein the patient can administer drug boluses when in pain. It’s the new modality where the time, dose and frequency of the drug are set in the pump. The pump also records the time when the patient required the boluses. We can modify the plan if the patient requires higher dosage and frequency of boluses. Epidural analgesia, ultrasound-guided nerve blocks and multimodal analgesia are the other types of analgesia in routine practice. Getting the analgesia plan is important which helps patients get proper sleep for a fresh healthy mind and for moving out of bed with energy. We anaesthesiologists choose the drugs and type of analgesia according to the patient’s age, and co-morbidities such as diabetes, asthma, hypothyroid, kidney function, etc. We also keep in mind any allergic history for pain killers which is to be avoided.
Get your biological clock set for faster recovery. Take care of your diet and have a regular sleep pattern; adequate analgesics when needed will help in getting you to move. Recovery involves teamwork, but you are the one who can lead that to success.