General patient information and 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. This resource also offers patients referenced advice and information about the risks of general and regional anaesthesia techniques.

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 postoperative rehabilitation
- need to stop smoking
Immediate pre-operative preparation
- continuation, alteration or cessation of normal medication or need for fasting
Choice of anaesthetic technique or 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
Information on pain management
- patient attitudes and expectations may be influenced by pre-existing pain and therefore must be assessed. Pre-operative anxiety has been demonstrated to be associated with increased pain after a variety of surgical procedures (Brander 2003, Caumo 2002, Kalkman 2003, Nelson 1998), and therefore, assessment of pre-operative anxiety and provision of information how to reduce anxiety are shown to be of benefit for reducing postoperative pain.
- early postoperative pain may be intense, and can delay rehabilitation and mobilisation unless appropriately treated. Different techniques of self-control, such as cognitive behavioural techniques, should be explained to manage different levels of pain immediately following surgery, within the first postoperative day and thereafter. Knowledge about potential self-control increases tolerance to pain (Weisenberg 1980) and may reduce analgesic consumption. The placebo effect should be used (Vase 2002), and the nocebo effect should be reduced by avoidance of negative or anxiety producing information. 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 plan for either inpatient or ambulatory surgery
  - information and training in the use of any objective pain assessment used after surgery, for example visual analogue scores
  - a realistic expectation of the intensity and duration of postoperative pain
  - demonstration and training in pain management techniques that require patient involvement (intravenous patient-controlled analgesia, patient-controlled epidural analgesia)
  - information about the medication to be used 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 or 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