After your operation - Same day discharge

This leaflet is about caring for yourself and the support available after your operation or procedure. It includes information about anaesthetics, follow-up procedures and when to seek help. It is general advice so you must also read your personal discharge letter, where any advice specific to you will be found.

In addition, there is a wide range of information on the Royal Orthopaedic Hospital website https//roh.nhs.uk/services and information.

After your operation or procedure, it is normal to experience some pain, swelling, bruising, tiredness and reduced coordination and reaction times. You may also be less steady than usual. These effects are to be expected and should gradually improve over time.

If you are worried at any time after returning home, please contact the hospital.

Between 7am and 7pm Monday to Friday call ADCU on 0121 812 3241.

Outside of these hours, please call 0121 812 3400 and ask for the Clinical Site Manager.

For general information and questions, you may contact your GP or NHS 111.

Your anaesthetic

You will find the type of anaesthetic you received in your personal discharge letter.

General anaesthetic
You are fully asleep during surgery with your breathing supported. Common temporary effects include tiredness, reduced coordination and reaction times and a sore throat for a few days.

For 24 hours afterwards, you must stay with a responsible adult and you must not drive. You should avoid making important decisions, signing legal documents, drinking alcohol, taking recreational drugs, smoking and vaping.

Intravenous sedation
You are relaxed during surgery but some awareness may remain. This is often used in conjunction with regional or local anaesthetic. After-effects are similar to a general anaesthetic.

Spinal or epidural anaesthetic
Local anaesthetic is injected near the spinal nerves, causing temporary loss of feeling and movement in the lower half of the body.

Rarely, fluid can leak internally from the area around the nerves, causing a headache. This gets worse on standing and improves when lying down. If you develop a headache, drink a large glass of water or a mug of tea or coffee, lie down in a quiet room and take a simple painkiller (preferably one containing caffeine) if safe for you. If symptoms continue for 4 to 6 hours, please contact the hospital.

Regional anaesthetic
Local anaesthetic is injected around nerves connecting with one limb, resulting in reduced feeling and movement in the limb. You may go home before the effect wears off, which usually happens within 6–24 hours. A pins and needles sensation indicates the effect is wearing off. If feeling and movement have not returned after 24 hours, please contact the hospital.

Local anaesthetic
Local anaesthetic is injected in the area around the surgical site. The effect usually wears off within 2–6 hours.

Looking After Yourself at Home

Using your limb
How much you can use your limb and whether you need a sling, brace, walking aid or special footwear, will be found in your personal discharge letter.

Managing swelling
Some swelling is normal and helps with healing, but too much can cause problems. To reduce swelling, elevate the limb so that the operation site is level with your heart. Use a sling or pillows as appropriate. You may apply a cold compress, such as a bag of ice or frozen peas wrapped in a towel. Do this for up to 20 minutes, three or four times a day. Do not use ice directly on the skin.

Painkillers and other medicines
If required, 3 days’ supply of prescription only painkillers will be provided. If more are needed a prescription must be obtained from your GP. You must buy your own supply of over-the-counter medicines recommended in your discharge letter. Take painkillers before local anaesthetic wears off (when you start to experience a pins and needles sensation) and take them routinely initially. The dose can be reduced as you recover.

Unless stated otherwise in your discharge letter, continue taking your regular medicines at the usual times.

Antibiotics
If you have been prescribed antibiotics, you must complete the full course even if you feel well. Antibiotics should be taken at regular intervals and according to the instructions on the label, as some have specific instructions about taking them before, after or with meals. Some may require blood test monitoring and this will be written in your discharge letter if it applies to you.

Dressings and bandages
Wounds and injection sites are usually covered with a dressing and sometimes a bandage.  Please keep wounds covered, clean and dry until they are healed.

How to manage the dressing depends on your procedure, so please follow this guidance:

• For injection treatments, remove the dressing after 24 hours.
• For CT or ultrasound-guided needle biopsy, remove the dressing after 48 hours.
• For hand and foot surgery, leave the padding and bandages in place until your first follow-up appointment.
• For other surgical sites, remove bandages and padding after 2 to 3 days, but leave the self-adhesive dressing in place. Do not disturb the self-adhesive dressing until your follow-up appointment, unless it becomes loose or soiled. If you need to change the dressing, wash your hands for at least 20 seconds with soap and warm, running water. Dry your hands with a clean towel and apply the new dressing without touching the absorbent pad.

Cast care
If you have a plaster or synthetic cast, please refer to the ‘Cast Care Instruction Leaflet’ for advice and additional contact numbers.

Wound closures
Your wound may be closed using stitches (either absorbable or non-absorbable), metal clips, paper strips or glue. Most wounds will heal within 10 to 14 days.

How your wound is closed, when and where it should be checked and any closures removed, will be found in your personal discharge letter.

If you need to see your GP practice nurse, please book your own appointment after you get home.

Do not remove stitches or clips yourself or ask a friend or relative to do this.

Nutrition and hydration
After surgery, your body needs protein, vitamins, minerals and fluids to heal. Protein is needed for growth and repair, while nutrients such as vitamin C, vitamin D, iron and zinc support wound healing and immune function.

You should aim to drink 1.5 to 2 litres of fluid a day. Hydration promotes the movement of nutrients around your body, removes waste products and helps prevent constipation, which is a common side effect of most painkillers and reduced mobility.

Avoid smoking and vaping, as nicotine may delay healing.

When to be concerned
Although complications are uncommon, it is important to recognise the warning signs.

Wound infection
Symptoms include redness, warmth around the wound, increasing pain or swelling and discharge that is not blood. The ROH has a dedicated wound infection help line which is available Mon – Fri 8am to 4pm. Telephone 0121 812 3312. At any other time, use the telephone numbers at the top of page one.

Nerve or blood vessel problems
Seek urgent help from the hospital if you notice increasing pain despite taking painkillers, cool, pale, blue or purple skin, new or prolonged pins and needles or increasing difficulty moving the limb.

Blood clots (DVT or pulmonary embolism)

Call 999 immediately if you experience sudden chest pain, difficulty breathing and coughing.

Seek urgent medical attention at your nearest Accident and Emergency Department if you experience sudden pain, redness or swelling in a leg or arm,

Sepsis

Call 999 immediately if you feel very unwell, confused, have a high or low temperature, breathing difficulties, pale or mottled skin, a fast heartbeat, or have not passed urine for several hours. For more information visit https://sepsistrust.org

Follow-up

Sometimes, wound care from your GP practice nurse is all that is needed. If a hospital follow-up appointment has been requested, it may be in the out-patient clinic, on the telephone or virtual. If an appointment is due, this will be found in your personal discharge letter.

• For an appointment due in less than a week, we will try to book it before you go home. If this is not possible, you will be telephoned as soon as the appointment has been arranged.
• For an appointment due in less than 2 weeks, we will also try to book it before you go home. If this is not possible, you will receive a letter with the appointment details.
• For an appointment due in more than 2 weeks, you will receive a letter with the appointment details.  
• If your surgeon requests a home visit from the Royal Orthopaedic Community Scheme, known as ‘ROCS’, this will be arranged after you go home. The ROCS team will call you within a few days to confirm the date.

For enquiries relating to your first follow-up appointment please contact the ADCU administration team on 0121 812 3242 or for ROCS telephone 0121 812 3277.

Paying a Compliment or Raising a Concern

Please let us know if you wish to pay a compliment or raise a concern about your treatment or care.  In the first instance, call ADCU on 0121 812 3241 and ask to speak to the nurse in charge. For support with either of these, contact PALS on 0121 812 3555.