After surgery, patients will go to the recovery room for close monitoring as they regain consciousness. Once consciousness is regained, the patient may return to the ward, or HDU or ICU depending on the condition of the patient.
❤️🩹 Enhanced recovery
This means that patients are able to return to their pre-operative state as fast as possible, and faster discharge as a result. Some ways to enable enhanced recovery is:
- Good prep for surgery (good physical reserve prior to surgery)
- Minimal invasiveness
- Adequate analgesia
- Nutrition (nutritional requirements increase post-operatively)
- Early oral diet and fluid intake
- Early mobilisation
- NG tube, drain and catheter removal
🩹 Analgesia
Analgesia allows the patients to mobilise early, ventilate the lungs, and ensure adequate oral fluid and dietary intake.
The WHO analgesic ladder is always useful to follow.:
- Step 1: Non-opioid ± adjuvant
- Step 2: weak opioid ± non-opioid ± adjuvant
- Step 3: stronger opioid ± non-opioid ± adjuvant
Analgesia should be prescribed regularly.
Patient controlled analgesia (PCA) may also be offered through IV blouses, however, it requires anaesthetist input and careful monitoring with special measures for complications (such as naloxone if a patient has respiratory depression).
Following laparotomy, one may implement a rectus sheath catheter for example. ↗️
Anaesthetics and the acute pain team are often involved.
NSAIDS are contraindicated in asthmatics, renal impairment, heart disease and PUD.
Nausea and vomiting
As discussed in post-surgical complications, PONV is very common. Therefore prophylactic anti-emetics are given such as ondansetron, dexamethasone, and cyclizine. Similar ones are given post-operatively (ondansetron, prochloroperazine, cyclizine).
There is some evidence that pressure on the P6 acupuncture pressure point reduces N&V ➡️
🚇 Tubes
- Drains are usually removed once they are no longer draining.
- NG tubes are best removed early to promote early oral fluid and diets.
- Catheters are removed when the patient may mobilise to the bathroom. This is known as a trial without catheter (TWOC) as the patient may find this difficult and go into urinary retention (more common in male patients)
🥗 Nutrition
Nutrition may be delivered orally and this is the most encouraged way post-operatively. If not orally, other enteral routes should be encouraged, such as via NG tube and even PEG (percutaneous endoscopic gastrostomy).
IV fluids may be given when the GI tract is not usable. This is known as TPN (total parenteral nutrition) and it is very irritating to veins and may cause thrombophlebitis therefore it is given through a central line.