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Patient Advice 

Regardless of the type of surgical procedure, pre-operative discussions between the patient and their anaesthetist and surgeon should cover specific topics to ensure that the patient knows what to expect and what is expected of them. It is important to involve the patient in optimising their general medical condition as many patients undergoing surgery have significant co-morbidity. In advance of admission to hospital, the patient should visit their primary care physician – or be referred to the appropriate hospital specialist – to stabilise their treatment for other medical conditions and to optimise their analgesic medication prior to surgery.

Educational resources, such as www.youranaesthetic.info, can inform patients about their forthcoming anaesthetic procedure and provide specific advice about the different anaesthetic and pain relief techniques for surgery. The information can be downloaded as copyright-free printed leaflets suitable for distribution to patients, or patients can visit the site themselves.

Topics for Discussion

• Pre-operative advice
  – targeted nutritional and dietary advice for obese patients in the weeks prior to surgery – even a few kilograms of weight loss may improve anaesthetic management and post-operative rehabilitation 
  
• Immediate pre-operative preparation
  – continuation, alteration or cessation of normal medication
  – need for fasting
  
• Choice of anaesthetic technique
  – general anaesthesia (with or without peripheral nerve blocks)
  – central neuraxial anaesthesia (spinal or epidural) with or without sedation
  – risks and benefits of recommended techniques on an individual patient basis
  – possibility of converting regional techniques to general anaesthesia
  
• Informed consent
  – provide adequate information regarding surgical, anaesthetic and postoperative pain management, including benefits and complications
  – if a transfusion may be required, ask the patient whether they would like to preserve some units of their own blood before the surgical procedure begins (if ‘auto-blood donation’ is part of the hospital practice)
  
• Main surgical complications
  – general complications such as deep vein thrombosis, pulmonary embolism, pneumonia, infection and seroma
  – special complications – bleeding and substitution of blood units (risk of infection with HIV, hepatitis B, hepatitis C)
  
• Information on pain management
  Patient attitudes and expectations may be influenced by pre-existing pain and therefore must be assessed. In addition, early postoperative pain may be intense, and can delay rehabilitation and mobilisation unless appropriately treated. Different techniques may be used to manage different levels of pain immediately following surgery, within the first postoperative day and thereafter. This pain management often involves a step-down approach from regional anaesthesia or systemic opioids to oral medication.

For a successful outcome of pain management:
– patients need to have a reasonable expectation of their likely postoperative hospital stay, or to know whether the procedure is being performed on an ambulatory basis
– information must be given on the hospital policy for pain assessment, for example, the use of visual analogue scores
– patients require a realistic expectation of the intensity and duration of postoperative pain
– pain management techniques that require patient involvement (intravenous patient-controlled analgesia, patient-controlled epidural analgesia) need to be properly demonstrated
– patients will require information about the medication to be taken after hospital discharge for management of pain and postoperative nausea

• After surgery patients should know what to expect with regard to:
  – location and size of the wound and dressings, and insertion of drains
  – intravenous fluids/blood transfusion/auto-transfusion equipment
  – possibility of a urinary catheter
  – associated postoperative symptoms, such as postoperative nausea and vomiting
  – when to return to normal oral fluids and nutrition
  
• Information on rehabilitation and physiotherapy should include:
  – approximate timetable for return to normal physical activities – both domestic and professional
  – advice for continuing rehabilitation following discharge and other postoperative care
  – explanation of the different types of rehabilitation, namely in-patient or out-patient
  – contact numbers for use after discharge and information on follow-up calls or clinic visits with the surgeon or care staff