Day of surgery
Preoperative Care
- The information you have supplied in your admission pack will be confirmed by a nurse.
- The nurse will check your blood pressure, pulse, temperature, oxygen levels, medical / surgical history, and height and weight.
- A thorough limb assessment will also be carried out, and please inform the admitting nurse if you have any bowel or bladder dysfunction.
- Dependent on your age and history you will also have an ECG (Electrocardiogram) done if you have not already had one before admission.
- The nurse will check if you have had routine blood tests prior to surgery, or if you require further blood tests.
- You may be reviewed by your anaesthetist prior to your surgery.
- You will have fasted from food and fluids for at least 6 hours prior to your surgery.
- You will be measured for and given a pair of TED (anti-embolic) stockings to help reduce the risk of a blood clot post-operatively. These are to be worn before you go into theatre and are to be kept on until the day of discharge. Nursing staff will assist you to take them on and off for showering.
- You will change into a hospital gown to ensure there are no delays for theatre.
Postoperative Care
- After your surgery you will remain in the recovery area until you are stable and comfortable then you will be transferred to the high dependency care unit for approximately 24 hours after your operation.
- Nursing staff will monitor your vital signs hourly. They will also monitor your wound, intravenous drip, your oral intake and urinary output.
- You are unlikely to have a wound drain or urinary catheter for a single level microdiscectomy.
- You are allowed to commence food and fluids as tolerated, if you do not feel nauseous.
- As you will need to remain in bed, your nurse will give you a hot towel wash on returning to the ward.
- If you have difficulty voiding in bed, you will be allowed to sit up, stand by the bed side or even walk to the toilet if required.
- You will have oxygen delivered through nasal tubing that needs to remain in place for the first 24 hours.
- Nursing staff will ask you regularly if you have any pain and will use a pain score system to assess your level of pain.
You will be asked to rate your pain on a scale of O to 10.
O = no pain
10 = worst possible pain
Based on your answer, nursing staff will arrange appropriate pain relief medication to be given to you.
- The type of pain relief available includes tablets, injections, hot packs and less often PCA’s (patient controlled analgesia) which allows you to administer your own pain relief via your drip. Note: PCA's are not routinely used and are only used if ordered by the anaesthetist.
- Please keep in mind that you may still feel some pain despite having pain relief, therefore, please inform your nurse if the medication does not reduce your pain or if your pain level increases. This may mean that your medication dose needs adjusting.
- Please advise your nurse when the pain first starts. Do not wait until the pain is bad or leave it for long periods before you take the medication as this means it will take longer to control the pain.
- If you are feeling nauseated, please let your nurse know so they can administer medications to control this and make you more comfortable
- You will be required to rest in bed initially post-operatively with head of the bed elevated to 30 degreee . As the anaesthetic wears off you will be allowed to mobilise with assistance. Please do not attempt to mobilise without assistance.
- Pressure area care will be attended by your nurses. This involves an assisted roll in bed which will help to relieve pressure, allowing skin care to be attended.
I usually review you while you are in the recovery room and then give your designated, next of kin, a call to let them know how the surgery went and how you are after surgery. Occasionally this will not be possible due to time restraints.
Day I
I will visit you today to discuss your operation and see how you are progressing.
Following the visit
- Your physiotherapist will visit you in the morning to assess you and assist you to mobilise as tolerated.
- Your intravenous antibiotics and intravenous fluids will be ceased.
- Your level of pain will be assessed to ensure you are on the appropriate medication.
- Your wound dressing will be inspected and monitored regularly. It will be left covered.
- I strongly recommend you take pain relief regularly (i.e. every 4 hours) for the first 48 hours to ensure your optimal comfort and recovery. Tablets are the most frequently used type of pain management, usually given 4-6 hourly and are a step forward in your recovery towards discharge home.
- You may sit out of bed as tolerated depending on your level of pain
- We advise you to change positions regularly between lying, sitting, standing and walking
- You will be commenced on a bowel regime to prevent and help avoid constipation
- The frequency of your vital sign monitoring will be reduced.
- Your nurse will assist you with a wash as instructed. The surgical site will be kept dry and covered.
- You will continue to wear your anti-embolic stockings throughout your hospital stay.
Day 2 to discharge
- We encourage you to gradually increase your activity levels each day with the aim of increasing your independence and mobility in preparation for your discharge home.
- I will visit you daily to ensure you are progressing well and discharge planning will continue post-operatively.
- You will be allowed to have a shower with a waterproof dressing over the wound. The wound dressing will be removed only on Day 3.
- Your physiotherapist will also continue to visit you daily to see how you are progressing and review your exercise and mobility regime
- If you have any questions or concerns regarding your discharge arrangements you may contact the Clinical Nurse manager, team leader, or discharge planner in the ward at any time to discuss these. Your nurse can make this contact for you.
Day 3 is the usual day for discharge
The dressing is removed, and the wound is left open. Ensure that there is no friction over the incision site with tight clothing and to ensure that the wound is kept clean and dry at all times.
If you are to drive home over a long distance, a dressing could be placed over the wound for the drive home. There is no need to keep the dressing on after.
Stitches are usually reabsorbable.
You are not to drive - for the first two weeks
On commencing driving, you should not be on any strong pain relief medication, and you should be able to check your blind spot with relative ease. Initial driving should be only over short distances and at nonpeak hours.
WORK:
You are advised time off work for the first six weeks.
When you get back to work you should engage only in light duties for the first three months’ time. During this period, you should limit activities that require repeated bending, stooping, twisting and awkward positions. If you do a desk job, change of posture is advised approximately every 30 mins. You should not lift objects over 7 to 10kgs.
