Fasting Instructions
No food or milk-containing fluids for 6 hours before your operation.
Please continue to drink clear fluids culminating up to 300ml two hours before surgery (water, clear fruit juice, black tea/ weak coffee).
Medications
Take all your usual medications.
If diabetic and taking insulin, take half your usual dose the night before and no insulin or diabetic tablets on the morning of your operation. If you are taking a “Gliflozin” diabetic tablet (Invokana, Forxiga, Xigduo or Jardiance), this should be ceased three days pre-operatively.
Discuss your use of blood thinners with Mr Buelow and Dr Brien Hennessy especially if you have cardiac stents or heart valve replacements. Aspirin can be continued. Paracetamol, Anti-Inflammatories and Pregabalin will usually be offered to all patients as a ‘pre-med’ (unless you have had prior problems with these medications).
Anaesthetic Plan
The typical anaesthetic sequence is listed below. This may be altered to suit your requirements. Firstly, all patients will be asleep for the operation with a full general anaesthetic. In addition to this, we will use two types of local anaesthetic injection after you go to sleep.
- A local anaesthetic injection +/- a catheter placed near your collar-bone
- A local anaesthetic in your shoulder, placed by Mr Buelow
Local Anaesthetic +/- Catheter
This is an injection of local anaesthetic using ultrasound guidance placed near your collar-bone to numb the nerves from your shoulder. The effect is to reduce pain in the shoulder for about 12 hours after the operation. For rotator-cuff repairs and shoulder stabilisations, an additional small catheter the size of a fishing line will be placed so that the analgesia can be maintained for a longer period. The catheter will be connected to a portable pump, which will trickle local anaesthetic overnight after your surgery. You may feel a numb sensation over your shoulder to your hand whilst the infusion is running. The catheter will provide continuous pain relief in the background but you will need other pain relief tablets. There will be additional analgesics ordered on an “if needed” basis. Simply speak with your nurse to access these if pain becomes problematic.
Direct Local Anaesthetic Injection
When you are asleep, Mr Buelow will inject local anaesthetic directly into your shoulder. This is very effective at reducing pain immediately after surgery.
After Your Operation
If you have had a local anaesthetic injection, you will wake up with some numbness in your shoulder down to your hand. As the local anaesthetic wears off you may notice some pain in your shoulder. For most people, it wears off gradually and they will be comfortable at rest. Occasionally the pain may come on quickly and can be severe. We understand this and will give you an immediate release pain tablet to take if required.
There is a range of medications used to help with pain management: Paracetamol, Anti-Inflammatories, Pregabalin and Tapentadol. In general, taking a small dose of a combination of analgesics usually results in much better pain relief with fewer side effects than taking a lot of one analgesic. It is important that you get to understand the analgesic medications and how they make you feel as you will be taking some home to manage your pain following discharge from hospital.
Most patients are relatively comfortable at rest but will experience some pain when mobilising the shoulder. Approximately 1 in 20 patients will experience a lot more pain and consume more pain tablets than other patients. If you need to stay in hospital overnight we have ward rounds daily by a pain management team supervised by a pain specialist who can help make you more comfortable if needed.
For more information visit www.betterpainrelief.org
After Hospital Discharge
It is important that your pain is well managed and under control following discharge from hospital. The aim is to reduce your pain to a level that allows you to perform activities of daily living soon after discharge without too much discomfort. Generally when you are resting, your shoulder should feel relatively comfortable, however, you may experience an increase in pain with activities such as physiotherapy. Night pain and sleep disturbance may persist for several months but will steadily improve.
If the pain becomes severe
- Reduce your activity, rest and elevate the shoulder and apply ice packs.
- Modify your exercises including physiotherapy that may be exacerbating the pain.
- Take extra pain relief when needed to allow you to maintain your comfort and mobility
It is important that you understand what medications to use when you leave the hospital. The ward pharmacist and nurse will help you with this.
If you are still having difficulties with pain management after two weeks please consult your GP for further advice and assessment.