Advice after your nerve block for surgery
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Introduction
You are having, or may have had, endovascular surgery to repair your abdominal aortic aneurysm (AAA). It is important that you feel able to take an active role in your recovery.
This booklet gives you information on what to expect in hospital after your operation, advice about recovering from your surgery; and aims to prepare you for your recovery at home. It can be used together with information leaflets given to you before your operation.
We hope this information is helpful. If there is anything you do not understand, please ask any of your vascular team (the doctors, nurses and other healthcare professionals involved in your care).
Your Operation – Endovascular AAA repair
This procedure will normally be carried out in the Radiology department in Interventional Radiology Suite.
The aorta is the main artery which carries blood away from the heart through your abdomen and to the rest of your body. An aneurysm occurs when the walls of your arteries weaken, causing a swelling. An abdominal aneurysm is a swelling in the aorta, which is in your abdominal / tummy area.
You are having, or may have had, an endovascular repair of your aortic aneurysm. Endovascular surgery for aortic aneurysm repair involves placing a stent into the artery spanning the aneurysm. The surgeon enters the artery via an incision in the groin.
Radiology doctors are also present as the stent is guided with X rays. There is no major abdominal surgery involved, and therefore it is a safer procedure and recovery is quicker.
Follow-up with regular scans will be required to monitor the position of the stent.
Your early recovery on the ward
Most patients will return to the ward after their operation. You may still have a drip, a catheter in your bladder and oxygen initially, which are removed over the first 24 hours.
Pain
The incisions (cuts) or puncutures in your groins are likely to be uncomfortable at first and you may have some bruising in the groin. The nurses will monitor your level of pain and any bruising. Initially you will be given painkillers either via an epidural (in your back) or intramuscular injection. Once you are eating and drinking, you will be able to take painkilling tablets by mouth. The pain will slowly improve but you may get twinges and aches for a few weeks.
Eating and drinking
Usually on the morning after your operation you will be able to eat breakfast and a light diet. Or if you feel like some supper on the day of your operation you may have it. It is normal to lose your appetite after surgery; as a result of this you may lose a little weight.
If needed, you can be seen by a dietician, who might recommend that you take supplementary drinks in order to support your recovery.
Your wound
There will be a dry dressing over the wounds in your groins. You will most likely have soluble stitches under the skin that do not need removing. Your wounds will be checked for any signs of infection, which will be treated if they occur.
Moving around
By day 1 you should be finding it easier to walk around and should be independently walking the full length of the ward. Moving around will not cause any damage to the graft, or to your wound, and will help your recovery.
If needed, a physiotherapist will give you individual assistance and instructions to help you regain your normal mobility.
Medication
Your doctors will review your tablets. Most people will be sent home on a small dose of aspirin to ensure the blood is less sticky and a statin to reduce your cholesterol levels. If you are unable to take aspirin an alternative drug may be prescribed. Any blood pressure tablets will be reviewed. You might already be on these tablets.
(See page 5 for more information about medication and surgery.)
Preparing for discharge
Most patients go home about 1 - 2 days after their surgery, although this may be longer if complications occur.
Preparing for home should start before your operation. It is a good idea to have someone to help look after you for a while, or some patients choose to live with a member of their family for a short time. Think about the tasks, or activities you do, which may be difficult especially if you have a caring role for someone else.
Stocking up on frozen or tinned items means you don't need to go shopping immediately.
If there are any complications with your recovery you may need to stay in hospital a little longer.
Recovery at home
Recovery times vary, and it can take couple of weeks to feel ‘back to normal’, and can depend on your health and activity before surgery.
Your wound
Your wound will be red at first but will gradually fade over six months or more. You can wash normally with mild soap and water when you have a bath or shower. If your wounds become red, sore or there is oozing please let your GP know, as this could be a sign of an infection. Protecting your scar from exposure to sunlight during the first year after having surgery will prevent the scar becoming darker.
Sleeping and feeling tired
It is normal to feel tired for at least 4 weeks after your operation. You may feel low in spirits. You might need a short sleep in the afternoon for a few weeks, as you gradually increase your level of activity. It is good for you and your family to be aware of this.
Diet and appetite
It can take a few weeks for your appetite and diet to return to normal and to regain any weight you may have lost in hospital. Try taking smaller regular meals. You may find your bowel motions take time to become more regular again.
Mobility, hobbies and activity - start slowly!
It can take several weeks to make a full recovery. During this time, you should not lift heavy objects, or undertake strenuous activities or sports such as golf. Taking regular exercise such as a short walk combined with rest is recommended for the first few weeks which you can gradually increase. Taking on light household chores, and walking around your house is a good starting point.
Working
When to return to work will depend on the type of job you do. Most people need to wait 4-6 weeks before returning to work and may work shorter hours for a few weeks and build back up to their normal hours.
Sex
You can resume your sex life when you feel comfortable. Rarely, men can have problems sustaining an erection after this operation as the nerve supply may be disturbed. This affects approximately 10% of men. It is not known what effect, if any, AAA repair has on a woman’s sex life. If you experience problems, your GP or consultant will be able to refer you to a specialist.
Driving
For safety and insurance reasons patients are unable to drive for 4 weeks after their operation. If you are in doubt, you should check with your GP and insurance company.
Exercise programme
Here are some tips for planning your exercise at home but your ability to exercise will depend on your fitness before surgery.
Week 1 Walk gently around the house and garden. Take an afternoon nap if needed.
Week 2 Take a daily 5-7 minute small walk around your house and garden. Take an afternoon nap, if needed.
Week 3 Take a short 7-15 minute walk in the morning and afternoon. Take a nap in the afternoon if needed.
Week 4 Take a 15-20 minute walk, twice a day if possible. Some days you might need a nap.
Complications and what to look out for
If you think that there is something wrong with your wound once you get home, you should contact your GP or the ward from which you were discharged.
The things to keep a look out for and to tell the vascular team are:
• pain in your legs when walking
• pain, redness or swelling in the wound
• continued poor appetite, upset bowel movements.
If you have other concerns or questions during your recovery at home, write them down in this booklet to ask at your follow-up appointment.
If you develop sudden pain or numbness in your legs that does not get better within a few hours, contact the hospital immediately. Likewise, if you experience severe pain in your back or stomach, pain or swelling in your calves, any shortness of breath or pains in your chest, you must seek medical attention as soon as possible.
If you need to go back to the hospital, it is best to ask someone to take you, or call for an ambulance.
Outpatient follow-up
After endovascular repair, the stent will be scanned at 4 weeks, 6 months and then every year, to make sure that the stent is in place and not leaking. Shortly after your first scan you will have a follow up appointment with the doctor in clinic, to check on your recovery.
After your first follow up appointment you will be invited along for future scans by the X-ray department who will send the results back to the consultant. If the scan is normal the consultant may not need to see you. You and your GP will be sent a letter informing you of the result and when to expect the next scan. About 10% of patients may need further treatment based on the results of their follow up scan.
Medications and Surgery
Angiotensin-converting enzyme inhibitors or ACE inhibitors (e.g., Enalapril, Lisinopril or Ramipril) should not be taken on the day of surgery.
Angiotensin II receptor blockers or ARBs (e.g., Candesartan, Losartan or Valsartan) should not be taken on the day of surgery.
Clopidogrel should be stopped 7 days pre-operatively for vascular operations except for all carotid endarterectomies or unless directed by your consultant. If you have had a stent inserted into your heart in the last 12 months, please inform your consultant and this will be discussed with a cardiologist as to the decision of when to stop your Clopidogrel.
Warfarin. Iby f you are currently taking Warfarin this will be discussed with you your consultant, regarding if this needs to be stopped and if you need a covering anticoagulant.
Direct oral anticoagulants or DOAC (e.g., Rivaroxiban, Apixaban or Dabigatran) . This should be stopped at least 48hrs prior to the procedure if high risk of bleeding. If your kidney function is abnormal, this may need to be discontinued for a longer time period prior to surgery. If you take Ticagrelor it will need to be discontinued for 5 days.
Your consultant will advise about this.
Following the procedure, the DOAC will be restarted after 24-72 hours at the discretion of your consultant. You will be started on an anticoagulation injection (e.g., Dalteparin) to help prevent blood clots on the evening of the procedure and daily until the DOAC is restarted. This will be stopped once the DOAC has been restarted.
T.E.D Anti-embolism stockings should never be given for arterial patients unless specifically directed by the consultant, if you are asked to apply a pair please can you question this with a member of the vascular team.
Along with toiletries, night clothes, etc., the vascular team actively encourages all our patients to bring in day clothes to wear on the ward whilst an inpatient and to have ready for discharge.
Research
The Vascular Team at Frimley Health are actively involved in vascular research projects. You may be asked to participate in a research project as a patient if you are felt to be suitable.
Your data may also be used for the National Vascular Registry if you require certain operations or procedures.
Should you have concerns about your personal data and its use, please discuss with your clinician involved in your care. Data is entered automatically to the national database unless you notify us of your dissent.
Any Questions?
If you have any questions about this procedure or treatment, please make a note of them (to ensure you do not forget them) and ask them at your next appointment. Alternatively you may contact your Consultant via his/her secretary.
Contact Details
Secretaries at Frimley Park
Mr D J Gerrard Mr Chong Mr Choudary 03006132141
Mr K Jones Mr Cleanthis Miss Moore 03006134291
Lt Col Sharrock Mr Ali Mr Dastur 03006132487
North Hants Hospital Basingstoke Secretary
Wexham Park Hospital Secretary
Vascular Specialist Nurses
Claire Martin Lead Vascular CNS FPH 0300 6136302
Tracey Craig Vascular CNS FPH
Andrea Croucher Vascular CNS FPH
Pabita Limbu Vascular CNS FPH
Kirstie lane Vascular CNS WPH 07770702053
Nessa Cababa Vascular CNS ASPH 07522618600
Contact us
If you have any queries relating to this information, please contact the Vascular surgery service.
About this information
Service:
Vascular surgery
Reference:
Y/042
Approval date:
7 March 2024
Review date:
1 March 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.