Post-operative Care?

The Recovery Room
Post-operative recovery starts in the Post-Anesthesia Care Unit (PACU). This unit is dedicated to meet the patient’s needs, thereby minimizing post-operative complications.

Post operative complications may include:

Anesthesia and Waking Up
Although it may only have taken moments to surrender to general anesthesia, recovery from anesthesia takes time. Throughout surgery, the anesthesiologist maintained deep sleep. During this time, muscles and fat absorbed some of the anesthesia, which helped to maintain levels of anesthesia in the brain and blood.

Most people do not experience any problems following surgery and anesthesia, but Post operative complications due to anaesthesia do occur and may be serious

It takes time for anesthesia to be eliminated from the body’s tissues. Many factors affect the amount of time a patient may spend in the PACU. These factors include the pre-operative medication, the type of anesthetic ,and the length of time an anesthetic was administered during surgery.

Hearing is the first sense to return following general anesthesia. This is why the PACU staff speaks in a reassuring tone while letting the patient know what they are doing.

Assessing Patient Needs and Vital Signs
In the PACU, the patient may wear certain devices to automatically monitor their vital signs. These devices include a blood pressure cuff, oximeter (records pulse) and EKG leads (monitors the heart). The IV remains in place to deliver medication and fluids intravenously. A urinary catheter collects urine to help the nurse monitor kidney function and hydration after many spine surgical procedures.

Every few minutes, a nurse assesses the patient’s overall condition. This helps to minimize post-operative complications. In addition, the nurse will place warm blankets around the patient’s body. It is common for patients to feel cold following surgery.

Pain Management
Pain is defined as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage.' It is a complex process influenced by both physiological and psychological factors.

Management of post postoperative pain has generally been shown to be inadequate. However,due to the effects of post operative pain management of pain is considered vital in the recovery of a patient after an operation. Statistics have shown that, patient recover faster and less post operative complications are incurred.

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• Postoperative pain can affects all organ systems and includes:
• Respiratory - reduced cough, atelectasis, sputum retention and hypoxaemia
• Cardiovascular - increased myocardial oxygen consumption and ischaemia
• Gastrointestinal - decreased gastric emptying, reduced gut motility and constipation
• Genitourinary - urinary retention
• Neuroendocrine - hyperglycaemia, protein catabolism and sodium retention
• Musculoskeletal - reduced mobility, pressure sores and increased risk of DVT

The effects of anesthesia linger following surgery, providing extended relief from pain. Other forms of pain management are used to augment the diminished effects of anesthesia.

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Patient Controlled Analgesia (PCA) is used post-operatively for pain control. This device allows a patient to self-dose pain relieving medication at the push of a button. PCA is a computerized pump programmed to dispense small doses of pain medication through the patient’s intravenous line (IV). Your physician will set the parameters so you will only get the appropriate dose. Pain relief is sustained to provide more consistent and better pain relief. Later, oral pain medications replace PCA. Patients are encouraged to notify the nurse immediately if pain is not sufficiently relieved. Below are some of the methods used in pain management.

Non-pharmacological methods of pain relief

• Preoperative explanation and education
• Relaxation therapy
• Hypnosis
• Cold or heat
• Splinting of wounds etc
• Transcutaneous electrical nerve stimulation (TENS)

Pharmacological methods of pain relief

Simple analgesia

• Paracetamol is a weak anti-inflammatory agent
• Modulates prostaglandin production in the central nervous system
• Can be administered orally or rectally
• Best taken on a regular rather than 'as required' basis.
• Overdose results in hepatic necrosis
• Often combined with weak opiates (e.g. dihydrocodeine = Co-dydramol)

Non-steroidal anti-inflammatory agents

• Inhibit the enzyme cyclo-oxygenase
• Reduces prostaglandin, prostacyclin and thromboxane production
• Also have weak central analgesic effect
• Often used for their 'opiate sparing' effects
• Side effects include:
  • Gastric irritation and peptic ulceration
  • Precipitation of bronchospasm in asthmatics
  • Impairment of renal function
  • Platelet dysfunction and bleeding

Opiates

• Most commonly used drugs are diamorphine, morphine and pethidine
• Diamorphine is a prodrug rapidly hydrolysed to morphine and 6-monoacetyl-morphine
• More lipid soluble than morphine with greater central effects
• Pethidine has only about 10% the analgesic potency of morphine
• All act on mu receptors in brain and spinal cord
• Mu 1 receptors are responsible for analgesia
• Mu 2 receptors are responsible for respiratory depression
• Side effects of opiates include:
  • Sedation
  • Nausea and vomiting
  • Vasodilatation and myocardial depression
  • Pruritus
  • Delayed gastric emptying
  • Constipation
  • Urinary retention

Routes of opiate administration

• Oral - available for codeine, dihydrocodeine and oramorph
• Subcutaneous - useful for chronic pain relief
• Intramuscular - produces peaks and troughs in pain relief
• Intravenous - reliable but can produce sedation and respiratory depression
• Patient-controlled analgesia (PCA) - patient determines own analgesic requirement
  • 'Lock-out' period prevents accidental overdose
  • Safe as sedation occurs before respiratory depression
• Epidural or spinal
  • Lipid soluble opiates (e.g. fentanyl) are normally used
  • Produces good analgesia with reduced risk of side effects

Proper Breathing
Lying flat for long periods of time can cause fluid to accumulate in the lungs. The nurse helps the patient to sit up to breath deeply and cough. This loosens secretions for elimination and helps to prevent pneumonia.

Deep breathing increases circulation and promotes elimination of anesthesia.

Some patients are instructed to breath into a spirometer. A spirometer is a device used to measure how deeply a patient is able to breath (eg, lung capacity) and acts as an incentive so you will see just how deeply you are breathing.

Regardless of what type of surgery you had, the most important advice is to always follow your doctor's specific instructions. If you do that, you're well on your way to achieving a successful recovery from spine surgery.