Guidance before shoulder surgery.
Pre operation guidance:
In the clinic you will be asked about your health and medication.
Past medical history:
You should inform your surgeon of all medical problems you may have or have suffered previously including; asthma, diabetes, high blood pressure, heart problems, heart attacks, strokes and epilepsy.
You should inform your surgeon of all drugs or medication you are taking especially; Warfarin (or other blood thinning tablets), Aspirin or anti-platelet medication, hormone containing tablets including (HRT (Hormone Replacement Therapy), the Pill (Oral Contraceptive Pill etc.) and heart or water tablets (diuretics). Blood thinning tablets such as Warfarin will usually need to be stopped prior to surgery.
Any allergies you may have, especially those to: antibiotics, Iodine, ElastoplastTM, Aspirin and Latex.
Smoking increases the risks of the operation including those related to the anaesthetic and the surgery itself. It is advisable to stop at least 2 weeks before the date of your operation. It is also preferable that you are off nicotine replacement, such as patches, before the operation. If you feel you can give up but need more time, it may be advisable to postpone the surgery to give you a chance to do so. Please discuss this with your General Practitioner and Surgeon.
Rings and jewellery:
Following surgery there may be some swelling of the arm or hand. Prior to surgery, any rings on the arm to be operated on will need to be removed. If you are unable to remove these rings yourself it is advisable to ask a Jeweller to remove them for you in advance of the operation. Rings that have not been removed before surgery may need to be cut off and this may cause damage to precious items.
What to bring:
You should bring a dressing gown and slippers. You may wish to bring a book, magazine or other entertainment. Even if you are anticipating going home the same day, it is advisable to bring items to allow a comfortable overnight stay such as toiletries.
Please also see the post operative guidance which contains further advice for making life easier in the post-operative period but may require some preparation.
Before and after and anaesthetic:
In almost all cases you will be asleep (under General Anaesthesia or GA) for the operation. Because of this, you should not eat or drink within 6 hours of the proposed surgery. You may be allowed to have clear drinks (water or black tea) up to 2 hours before the proposed surgery. Any non clear fluids such as milk or tea/coffee with milk and fruit juice etc. count as food and should be avoided for at least 6 hours before surgery.
As you are likely to require a General Anaesthetic you will not be able to drive home after the operation and need to have made arrangements for a responsible adult to be with you for 24 hours after the surgery.
You should not make any important decisions (sign legal papers etc.) or operate machinery for at least 24 hours after surgery.
The day of the operation:
On the morning of your operation you should take your usual medications with a small sip of water or clear fluids (see above) unless otherwise directed. Certain medications are best omitted such as ACE inhibitors (eg: Ramipril, Lisinopril and Captopril). If in doubt please check with your surgeon.
Before the operation your surgeon will see you and go over the operation again, confirming your consent for the operation. The side of the operation (left or right arm) will be checked with you and with the consent form. The site of the surgery will be marked with a pen. This is another chance to ask any remaining questions you may have.
The anaesthetist will see you and discuss the anaesthetic and any blocks or injections that may be necessary.
Transfer to Theatre:
When it is time for your operation you will be taken to the Theatre Suite. You may be wheeled down in your bed or choose to walk. You will be taken to the Anaesthetic Room next to the Theatre. You will usually be put to sleep in this room and be taken thorough to the theatre once you are asleep.
After the Operation:
You will wake up in the Recovery Room where a nurse will check on you until you are fully awake. You may eat and drink when you feel able. Once you are awake and comfortable you will be taken back to the ward.
Your surgeon will explain the operation and results to you. However, although you will be awake enough to hold a conversation and acknowledge the explanation, many people find they do not remember this. Do not worry as you should be given clear rehabilitation guidelines by the physiotherapists on the ward and arrangements will be made for you to be seen again in the clinic.
In the clinic, the explanation of the operation and findings can then be repeated and any questions answered. There are often intra-operative images or photos, particularly if you have had key-hole (arthroscopic) surgery and these will normally be explained to you.
Going Home or Staying in Overnight:
Once you are awake, comfortable, had something to eat and drink and the Nursing Staff are happy with your condition, you may go home. Most people can go home the same day even if their operation is in the afternoon. However, some people will choose or need to stay in over night. If so you can go home the next morning as soon as the Nursing Staff are satisfied with your condition.
If you have had an anaesthetic block or injection you may still have a numb, tingly or floppy arm. This will recover but may take 24 to 48 hours to do so. The prolonged block may be irritating but does mean that the arm is more comfortable after the operation. Care should be taken of the arm while it is numb, as during this time there is the potential to unknowingly injure it.
You will usually be given pain-killers and anti-inflammatories to take home with instructions when to take these. Do not exceed the recommended doses.
You should contact the ward if you have any concerns (Spire