Advice after your nerve block for surgery
On this page…
Introduction
You are having, or may have had, open surgery to repair your abdominal aortic aneurysm (AAA). It is important that you feel able to take an active role in your recovery. This information is designed to give you further information on what to expect after your operation and advice about recovering from your surgery. It can be used together with additional information given to you before your operation.
This information is designed to answer some of your questions. The doctors and nurses and other healthcare professionals involved in your care will also be available to help you with any queries. Our aim is to inform you about what to expect in hospital and prepare you for your recovery at home.
The topics covered in this Information include:
· Your operation
· Your early recovery on the ward
· Preparing for discharge
· Recovery at home
· Exercise programme
· Complications and what to look out for
· Outpatient follow up
· Looking after yourself
· Recovery tips
· Recovery record
· Glossary
· Useful numbers and contacts
We hope that this information is helpful. If there is anything you do not understand, please ask any of your vascular team.
Your Operation – Open AAA repair
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, open surgery to repair your aortic aneurysm.
Open surgery for aortic aneurysm repair is a major operation. The aorta is cut open, so that an artificial graft can be stitched inside. Sometimes the graft will attach onto the arteries at the top of each leg, and you may have an additional wound in your groins. The graft will stay in place forever.
Your early recovery on the ward
Most patients spend the first 24-48hrs in the intensive care unit (ICU). When your condition is stable you will return to the ward. You may still have a drip, a catheter and oxygen.
Pain
The incision (cut) in your abdomen is likely to be uncomfortable at first. The nurses will monitor your level of pain and initially you will be given painkillers via a tube in your back, or by a machine that you control yourself. 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 between 4-6 weeks.
Eating and drinking
After surgery sometimes your bowel will stop working; and initially you will only be allowed sips of water. When your guts are working, you will be allowed to start drinking and then build up to a light diet, and your drip will be stopped. This can take up to 5 days. Occasionally your bowels can take a little longer to start working again and you may need to have a nasogastric tube inserted to relieve any symptoms of nausea or bloating. It is normal to lose your appetite after surgery; as a result of this you may lose weight.
You may be seen by a dietitian who might recommend that you take supplementary drinks to provide more nutrition to build your strength and aid recovery.
Your wound
There will be a dry dressing over your tummy wound. Your would will be closed with stitches, clips or glue. Stitches and clips will usually be removed between 14 and 21 days after the operation. If your stitches are not removed in hospital it may be arranged for your GP’s practice or district nurse to remove them and check your wound. Your wound will be checked for any signs of infection, which will be treated if they occur. If you have clips, the ward will need to provide you with clip removers on your discharge.
Moving around
You will be helped to start moving and walking as soon as possible. Initially by sitting in the chair, and walking to the bathroom and around the ward. During this time you will be given a daily injection of heparin to reduce the risk of blood clots. It is a good idea to exercise your legs in bed. The physiotherapist will help you to cough and breathe, and, if needed, will give you individual assistance and instructions to help you regain your normal mobility. Moving around will not cause any damage to the graft, or to your wound, and will help your recovery.
Medication
The 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 maybe prescribed. Any
blood pressure tablets will be reviewed. You might already be on these tablets.
Preparing for discharge
Preparing for home should start as early as possible. Discharge is usually planned for about 10 days after 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 complications with your recovery you may need to stay in hospital a little longer.
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, pat when drying. If your wound becomes red, sore or 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 4-6 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!
The muscles underneath your wound may take up to 6-8 weeks to heal fully. 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 that you do. Most people need to wait 6-12 weeks before returning to work, and may work shorter hours for a few weeks, and build back up to their normal hours. Your GP will be able to advise you further.
Sex
You can resume your sex life when you feel comfortable. Sometimes, men 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 may be able to provide treatment to help.
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:
| Week 1 | Walk gently around the house. Take an afternoon nap. |
| Week 2 | Take a daily 3-5 minute small walk around your house and garden. Take an afternoon nap, if needed. |
| Week 3 | Take a short 5-10 minute daily walk in the morning and afternoon. Take a nap in the afternoon if needed. |
| Week 4 | Take a 10-20 minute walk, twice a day. You may also still need a daily 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 about, are:
- Pain in your legs when walking
- Pain, or a 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 leaflet 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 then 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.
Outpatient Follow Up
After an open repair, recovery is slower, but the need for followup is less. You may be seen in the vascular clinic 4-6 weeks after your discharge. Remember to bring a list of your queries if you have them. You will not need a scan to check the graft, but the doctor will ask you a few questions on how you have been doing. Once you have recovered from your operation, you will be discharged back to the care of your family doctor.
Looking after yourself
Aneurysms are often caused by arterial disease, or atherosclerosis. There are certain factors that make people more at risk from atherosclerosis or peripheral vascular disease.
These include
- Age
- Smoking
- High blood pressure
- High cholesterol
- Diabetes
- Being overweight
- Lack of exercise
Part of your medical treatment will be to reduce these risk factors
Stop smoking
Smoking is a major risk for arterial disease, and also increases getting a chest infection and slows your recovery. We can help you to stop and refer you to our smoking cessation counselor, who may suggest tablets or patches to help you.
Eat healthily
Being overweight reduces your general mobility and can slow your recovery. Eat well, according to your appetite. Concentrate on low fat diet foods and try to include fruit and vegetables.
Exercise
Take a nap if needed. As you recover try to increase your activity, to having a daily walk.
Exercise can boost your immune system and improve recovery. Take regular exercise or a short walk every day.
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. If you are currently taking Warfarin this will be discussed with you by 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.
GLOSSARY
| Abdomen | The tummy |
| Anaesthetist | Specialist doctor who gives the patient the anaesthetic for an operation. |
| Aneurysm | Swelling of an artery due to a weakening of the vessel wall by atherosclerosis. |
| Aorta | The main blood vessel carrying blood from the heart to the whole of the body. |
| Aortic Aneurysm | An aneurysm affecting the aorta, usually in the abdomen area. |
| Artery | Blood vessel taking blood from the heart. |
| Atherosclerosis | Narrowing of the artery by plaque - a fatty substance. It is associated with people who smoke or have diabetes. |
| Cholesterol | Type of unhealthy fat in the blood. |
| Deep vein thrombosis |
A blood clot in the large veins in the leg. |
| Diabetes | A disease where people are unable to control the level of sugar in their blood. |
| Endovascular | A procedure/operation that is performed from with the blood vessel. |
| Graft | The man-made material used to patch / repair the diseased artery. |
| Heparin | Blood thinning drug given by injection to reduce the risk of blood clots. |
| Hypertension | High blood pressure. |
| Physiotherapist | Healthcare professional trained in the care of patients to aid recovery with coughing and breathing exercises, and mobility assessment. |
| Statins | Medication to reduce the amount of cholesterol in your blood. |
| Vascular Surgeon | A surgeon who specialises in the surgery of blood vessels and circulation. |
Contact Details
Secretaries at Frimley Park
Mr D J Gerrard, Mr Chong, Mr Chaudary 0300 613 2141
Mr K Jones, Mr Cleanthis, Miss Moore 0300 613 4291
Lt Col Sharrock, Mr Ali, Mr Dastur 0300 613 2487
North Hants Hospital Basingstoke Secretary
Wexham Park Hospital Secretary
Vascular Specialist Nurses
Claire Martin Lead Vascular CNS - FPH 0300 613 6302
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/034
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.