After your operation/surgery

Enhanced recovery after surgery (ERAS) 

Enhanced recover after surgery or ERAS is a protocol proven to help you to physically and mentally prepare for your surgery and improve your recovery after surgery. It focuses on three main stages of your journey. The preoperative stage (before the operation), intraoperative stage (during the operation) and the postoperative stage (after the operation). 

​ERAS protocol aims to get you back to pre-operative function as quickly as possible. It is research-based, and evidence shows that the earlier a person gets out of bed and starts walking, eating and drinking after having an operation, the shorter their recovery time will be.​ 

​You will likely hear the doctors, nurses and therapy team talking about ERAS and its importance when you are in hospital. 

It may be that you are seen by a member of the therapy team immediately following your surgery (day 0) to help with getting you out of bed and moving. This is in line with ERAS to help reduce the risk of infections and complications post-operatively. 

Attachments 

Depending on the type of surgery you are having, you may have a number of attachments which you are connected to. This can feel scary and sometimes makes it difficult to move around however the team of nurses and physiotherapists are very experienced and will help you to move around safely. Even if you have lots of attachments, this will not be a barrier to getting out of bed and walking. 

The most common attachments are: 

• urinary Catheter 
• wound drains 
• intravenous cannulas to provide medications such as antibiotics, fluids or pain relief
• PCA (Patient controlled analgesia) - this is a morphine pump which you can control when you feel pain (it will deliver a certain amount over a set time period ensuring that you are unable to overdose)
• arterial line – this is inserted into an artery normally near your wrist which monitors your blood pressure

Eating and drinking after surgery   

In some case, patients will be advised to eat and drink shortly after surgery, while others will be given individualised advice to follow.  

Commonly used terms regarding diet

• Sips of water 
• Clear fluids: water, weak squash, weak black tea, clear soup (Bovril drink), jelly 
• Free fluids: smooth fruit juice, milk and milky drinks such as hot chocolate and milkshakes (milkshakes are available on the ward) 
• Light diet: small portions, soft foods and it is a temporary measure after surgery, as you are being build up to regular diet (depending on what is allowed after your surgery). 
• Nausea, taste changes and dry mouth is common after surgery. You may not feel hungry shortly after surgery, but eating small amounts regularly once allowed can help. 

Some people might be advised to follow a texture modified diet – please follow the advice given to you by the specialist dietitian and surgical team.   

Expectations after surgery 

After your surgery you will be encouraged to do the following things to ensure a faster recovery.

Sitting out of bed in chair 

it may be expected of you to sit out of bed into a chair following your surgery if it is appropriate to do so. Your nurse or therapists will support you with any attachments that you may have. It is Important you try to sit out as soon as you can to reduce the risk of chest infections and to help you to take bigger breaths.  This will reduce the risk of post operative complications. 

You will be expected to be sitting out at mealtimes during the day to help aid digestion 

Walking to the toilet and back 

Your nurse and therapist will encourage you to walk to the toilet and back following your surgery. Depending on the time you return from theatre, this can be on the same day as your surgery. They will support you with any attachments you have.  

The sooner you are up walking, the quicker certain attachments such as catheters can be removed if appropriate. 

If you are having a more complex operation, the therapy team will be seeing you and will be encouraging you to mobilise daily. 

Wearing your own clothes 

You are encouraged to change out of your theatre gown and/or hospital wear into your own, comfortable clothing when you feel able to do so. 

Exercise programme 

If you have been provided with exercise sheets, it’s important to complete these in your own time to maintain your strength and help with your recovery. 

Incentive spirometry

If you are having a more complex surgery, you may be provided with an incentive spirometer. This is a device that will help you to take deep breaths. Your therapist or nurse will show you how this works once you return to the ward. It is important you complete 6-10 breaths every hour in your own time to help keep your lungs nice and inflated. 

If you have not been provided with an incentive spirometer, it is important you complete deep breathing exercises regularly to keep your lungs nice and inflated. 

Pain management 

It is normal to feel some pain when doing any of the above activities therefore you are encouraged to take regular pain relief to facilitate this. If you feel your pain is limiting you from doing the above please let your nurse know. 

Pain relief after surgery for EPOC patients

The type and amount of pain relief you will be offered will depend on the operation you are having and your pain levels after the operation. Some people need more pain relief than others. 

Generally, some degree of pain or discomfort should be expected during your recovery. Stronger painkillers can be very good at relieving pain, but may have side effects, like nausea, constipation and addiction in the long term. 

Nursing and medical staff in EPOC will assess your pain needs using a pain scale with the aim to alleviate any discomfort you may have. If you have any side effects these can treated and the pain relief changed if required. 

You may be offered the following types of pain relief:

• pills, tablets or liquids to swallow – these are used for all types of pain. They typically take at least half an hour to work. You need to be able to eat, drink and not feel sick for these drugs to work. 
• injections – these may be intravenous (through your cannula into a vein for a quicker effect) or intramuscular (into your leg or buttock muscle using a needle, taking about 20 minutes to work). 
• patient-controlled analgesia (PCA) – this involves a machine with a push button which, when pressed by you, delivers a small dose of strong pain killer directly into your cannula or drip. It is programmed to ensure that you cannot give yourself an overdose. A PCA puts you in direct control of your own pain relief. 
• local anaesthetics and regional blocks including spinals and epidurals – these types of anaesthesia can be very useful for relieving pain after surgery. The Royal College of Anaesthetists have more information on this.