After any operation, you'll have some side effects. There is usually some pain with surgery. There may also be swelling and soreness around the area that the surgeon cut. Your surgeon can tell you which side effects to expect.

There can also be complications. These are unplanned events linked to the operation. Some complications are infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions.

Your surgeon can tell you how you might feel and what you will be able to do - or not do - the first few days, weeks, or months after surgery. Some other questions to ask are

• How long you will be in the hospital
• What kind of supplies, equipment, and help you might need when you go home
• When you can go back to work
• When it is ok to start exercising again
• Are they any other restrictions in your activities

Following your surgeon's advice can help you recover as soon as possible.

When you face surgery, you might have many concerns. One common worry is about going under anesthesia. Will you lose consciousness? How will you feel afterward? Is it safe?

Every day about 60,000 people nationwide have surgery under general anesthesia. It’s a combination of drugs that’s made surgery more bearable for patients and doctors alike. General anesthesia dampens pain, knocks you unconscious and keeps you from moving during the operation.

“Prior to general anesthesia, the best ideas for killing pain during surgery were biting on a stick or taking a swig of whiskey,” says Dr. Emery Brown, an anesthesiologist at Massachusetts General Hospital in Boston. Things improved more than 150 years ago, when a dentist in Massachusetts publicly demonstrated that the anesthetic drug ether could block pain during surgery. Within just a few months, anesthesia was being used in Australia, Europe and then around the world.

“General anesthesia changed medicine practically overnight,” says Brown. Life-saving procedures like open-heart surgery, brain surgery or organ transplantation would be impossible without general anesthesia.

General anesthesia affects your entire body. Other types of anesthesia affect specific regions. Local anesthesia—such as a shot of novocaine from the dentist—numbs only a small part of your body for a short period of time. Regional anesthesia numbs a larger area—such as everything below the waist—for a few hours. Most people are awake during operations with local or regional anesthesia. But general anesthesia is used for major surgery and when it’s important that you be unconscious during a procedure.

General anesthesia has 3 main stages: going under (induction), staying under (maintenance) and recovery (emergence). NIH-funded scientists are working to improve the safety and effectiveness of all 3.

The drugs that help you go under are either breathed in as a gas or delivered directly into your bloodstream. Most of these drugs act quickly and disappear rapidly from your system, so they need to be given throughout the surgery. A specially trained anesthesiologist or nurse anesthetist gives you the proper doses and continuously monitors your vital signs—such as heart rate, body temperature, blood pressure and breathing.

“When patients are going under, they experience a series of deficits,” says Dr. Howard Nash, a scientist at NIH’s National Institute of Mental Health. “The first is an inability to remember things. A patient may be able to repeat words you say, but can’t recall them after waking up.”

Next, patients lose the ability to respond. “They won’t squeeze your fingers or give their name when asked,” Nash says. “Finally they go into deep sedation.”

Although doctors often say that you’ll be asleep during surgery, research has shown that going under anesthesia is nothing like sleep. “Even in the deepest stages of sleep, with prodding and poking we can wake you up,” says Brown. “But that’s not the case with general anesthesia. General anesthesia looks more like a coma—a reversible coma.” You lose awareness and the ability to feel pain, form memories and move.

Once you’ve become unconscious, the anesthesiologist uses monitors and medications to keep you that way. In rare cases, though, something can go wrong. About once in every 1,000 to 2,000 surgeries, patients may gain some awareness when they should be unconscious. They may hear the doctors talking and remember it afterward. Worse yet, they may feel pain but be unable to move or tell the doctors.

“It’s a real problem, although it’s quite rare,” says Dr. Alex Evers, an anesthesiologist at Washington University in St. Louis. “Anesthesia awareness can lead to post-traumatic stress disorder,” a severe anxiety disorder that can arise after a terrifying ordeal.

Scientists have developed strategies to identify and prevent anesthesia awareness. Small studies suggested that brain monitors might help. But in 2008, Evers and his colleagues reported the results of the largest study to compare different techniques. Brain monitoring did no better than standard monitoring in preventing anesthesia awareness.

Addiction to alcohol or drugs increases the risk for anesthesia awareness, but doctors can’t accurately predict who will be affected. A research team in Canada identified variations in a gene A stretch of DNA, a substance you inherit from your parents, that defines characteristics such as eye color, your risk for disease and your likely response to different medications. that may allow animals to form memories while under anesthesia. Ongoing studies are exploring whether this gene plays a role in anesthesia awareness in people.

Other researchers are searching for genes that may affect how anesthetic drugs are processed, or metabolized, by the body. Genetic differences might affect the proper dosage or the selection of drugs for each patient.

Nash and his colleagues have found that studies of the common fruit fly may offer clues to how genes affect anesthesia. When certain repeating segments—called copy number variations—are snipped from the fly’s genome, it affects the insect’s response to anesthesia. Copy number variations are known to affect human responses to other drugs. Nash suspects that these gene segments may also affect how patients react to anesthesia. “As researchers learn more, I expect genetic screening will become more common in the clinic,” says Nash.

After surgery, when anesthesia wears off, you may feel some pain and discomfort. How quickly you recover will depend on the medications you received and other factors like your age. About 40% of elderly patients and up to one-third of children have lingering confusion and thinking problems for several days after surgery and anesthesia.

Right now, the best cure for these side effects is time. Brown and his colleagues are working to develop drugs to help patients more quickly emerge and recover from general anesthesia.

Anesthesia is generally considered quite safe for most patients. “Anesthetics have gotten much safer over the years in terms of the things we’re most worried about, like the patient dying or having dangerously low blood pressure,” Evers says. By some estimates, the death rate from general anesthesia is about 1 in 250,000 patients. Side effects have become less common and are usually not as serious as they once were.

Don’t delay important surgery because of fear of anesthesia. If you have concerns, talk with your doctor. It might help to meet in advance with the person who will give you anesthesia. Ask what kind of anesthesia you will have. Ask about possible risks and side effects. Knowing more might help you feel less concerned about going under.

When You Go Under

General anesthesia has 5 major effects on your body. Researchers are working to develop drugs that target each of these characteristics:

• Lack of Consciousness. Keeps you from being aware of your surroundings.
• Analgesia. Blocks your ability to feel pain.
• Amnesia. Prevents formation of memories.
• Loss of Movement. Relaxes your muscles and keeps you still during surgery.
• Stable Body Functions. Stabilizes your heart rate, blood pressure, temperature, breathing and kidney function.

The following information describes basic after-care recommendations that apply to many types of surgery. Following these precautions will help prevent complications from your surgery. These basic suggestions to improve your recovery may be supplemented by other directions from your doctor and nurse.

Managing pain

Pain medication will be ordered for you as needed. You are encouraged to take the prescribed pain medication in order for you to be comfortable during your recovery. Pain may prevent you from doing the activities that help with your recovery. If you have any concerns about your pain management, please do not hesitate to ask your doctor or nurse. Please report any new, increasing, or unrelieved pain to your doctor.

Surgical site care

Follow your doctor’s instructions about caring for your surgical site or incision area. Watch for any separation, bleeding, or signs of infection which include:

• Redness
• Pain
• Swelling
• Drainage of fluid or pus
• Heat at incision site
• Fever (which is usually a temperature of 101 oF or higher)

If you notice any of these problems, call your nurse or doctor right away.

Care of your incision

Wash your hands before and after touching your incision(s). Hand washing is the best way to prevent infection. It is normal to have some numbness around the incision for some time after surgery. This may subside as the incision heals. If you have been sent home with staples in your incision, then see your regular doctor to have your staples removed. You may shower with staples in place, unless your doctor has told you not to.

If you have been sent home with sterile tape over your incision, you may shower, but be gentle around the tape. Use regular soap and water. Wash your incision gently, and then pat the incision dry. Do not pull, tug, or rub the tape. If the tape has not fallen off 2 weeks after surgery, then you may peel the tape off gently. Check with your doctor about applying creams or lotions to your incisions. Apply these only after the tape has fallen off or has been removed.

Avoid exposing your incision to the sun. This can cause the incision to become red. Scars turn white over time without exposure to the sun.

You will receive information from your doctor about any dressing changes or suture removal.

Constipation

A possible complication of surgery is constipation (no bowel movement or stool over the course of several days). Possible causes of constipation include: anesthesia and pain medications (which can slow the movement of the intestine); not drinking enough fluids; and abdominal surgery. Drinking fluids and eating fiber can help prevent constipation. Please notify your nurse or doctor if you are not passing any gas, have abdominal pain, and/or feel bloated.

Pneumonia prevention

When admitted to the hospital, you may be given an airway clearance device before surgery such as an Incentive Spirometer. Use of this device exercises your lungs and helps clear them of anesthesia gases after the procedure. We recommend using it ten times every hour while you are awake. Generally, outpatients do not receive the airway clearance device. While you are awake in bed, you can improve your recovery by turning, coughing, and deep breathing each hour.

If you have an abdominal incision, splint the incision when exercising your lungs. Splinting an incision is a way to support the incision and surrounding tissues using a stiff pad or a small firm pillow placed over or against the incision on your abdomen. It is a way to immobilize or cushion those movements so that you can fully expand your lungs or cough with a little less discomfort and reduce pain during coughing. Coughing will not affect the incision.

Activity

After the procedure, and when the anesthesia has worn off, get up and be active as soon possible. This will help your muscles stay strong and will lead to a faster recovery. We encourage you to be active as soon as it is safe, which is usually in the evening after your procedure. We recommend that you walk, sit up in a chair, or at least turn frequently in bed.

As you continue with your recovery, follow the specific activity instructions given by your doctor. Different surgeries require different limitations on activity. Generally, you should not lift objects heavier than 10 pounds for 6 to 8 weeks. Lifting heavy objects too soon may weaken your incision. Your doctor will tell you specific activity instructions for your type of surgery.

Plan your daily activity so that you can rest often. Do not expect your energy level to be the same as it was before surgery. Your body needs more energy to heal, and this may cause you to feel weak or need to take naps.

Preventing blood clots

Blood clots are more likely to occur when a patient is not moving for a long time, such as after an operation or during recovery in bed. A type of blood clot that can form during your surgical recovery is called a Deep Vein Thrombosis (DVT) and can lead to Pulmonary Embolism (PE), a clot that travels to your lungs. One of the best ways to prevent blood clots from forming is to start being active as soon as possible. You may also be given a medication that helps prevent these clots. The medication is injected just under the skin. Bruising at the injection sites is common with this medication.

Diet

Resume your regular diet when you return home, unless your doctor has put you on a special diet. You may not feel like eating regular portions right away. It is normal to have less of an appetite after surgery. This could return to normal when your activity level increases. In the beginning, try eating small meals several times a day.

Choose high-protein foods to help your body heal. These may include such foods as chicken, beef, cheese, tofu, milkshakes, and ice cream.

Drink lots of fluids and include fiber in your diet, such as fresh fruits, vegetables, and whole grain cereals or breads. Eating these foods and drinking lots of fluids will help prevent constipation. They also promote normal bowel function, especially if you are taking narcotic pain medication.

Take nausea medication as needed if it has been ordered by your doctor. Let your doctor know if you have nausea or vomiting that lasts longer than 24 hours. If you have had neurosurgery, follow your doctor’s specific instructions about reporting nausea.

Driving

Check with your doctor about when you will be able to drive. Usually, you will not be able to drive for 6 to 8 weeks after surgery. However, this can vary depending on the type of surgery that you have had. Never drive while taking narcotic pain medications.

Physician follow-up

Your doctor will provide you with information about when to schedule a follow-up visit.

These basic suggestions to improve your recovery may be supplemented by other directions from your doctor and nurse.

No one should have to put up with severe pain after surgery nowadays. There are now many different ways to effectively relieve this kind of pain. It’s important to let nurses and doctors know about any pain you might have.

If you have pain after an operation, it needs to be treated. Pain in the area of the surgical wound isn’t only sometimes very unpleasant, it can also delay your recovery. It’s generally important to start getting back on your feet again as soon as possible after surgery in order to stop your muscles from getting weak. Pain can prevent you from getting up and walking around. Lack of movement can also increase the risk of blood clots in blood vessels (thrombosis) and affect your ability to take deep breaths or cough. This can lead to serious complications.

What is important before surgery?

Pain after surgery is called post-operative pain (“post” means “after”). But pain management already starts before surgery, when the treatment is being planned. The doctor should tell you about possible pain after surgery so that you can be prepared for it.

It also helps to know what treatment is typically used to relieve pain after your kind of surgery, and what symptoms could be signs of complications. If it’s possible to manage your pain treatment yourself, it’s good to know about that before having the operation. The medical name for this kind of pain management is “patient-controlled analgesia” (PCA).

It’s also important to tell doctors about any pain you may already have before surgery, or if you are already taking any medication. People who already take strong painkillers (or drink alcohol or use other drugs) on a regular basis may need different kinds of medication after surgery.

How can you describe the pain?

Patients are usually asked whether they are in pain as soon as the anesthetic wears off after surgery. The more accurately you can describe your pain, the better it can be treated. To effectively treat the pain, nurses or doctors need to know

• where the pain is (near the wound or somewhere else),
• what kind of pain you have (e.g. stabbing, dull or burning pain),
• how bad it is (mild, moderate or severe), and
• how bad the pain is at rest and when moving.

During your stay it is also important to tell nurses and doctors about how long the pain lasts, and if/when it goes away or gets worse.

Young children who can’t yet speak often show that they are in pain in other ways. They may cry or wail. But certain facial expressions, sounds or changes in behavior can also be signs of pain. Here it’s important that parents help the nurses to recognize these signs.

The same is true for people who aren’t able to express themselves properly. Someone close to them should help here, too.

What are the pain treatment options?

The severity of pain after surgery will depend on whether it was a big or small operation, for instance on the heart, abdomen (belly area) or knee. Sometimes the pain goes away quickly, and sometimes treatment is needed for a couple of days. Depending on the type of procedure, painkillers used during surgery may continue to have an effect afterwards.

After smaller operations with milder pain, non-opioid painkillers are generally used. These include medications such as acetaminophen (paracetamol), metamizole and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or diclofenac. They can either be taken as tablets, injected, or used in the form of patches, suppositories or drops.

After bigger operations with moderate to severe pain, stronger painkillers are usually needed. Opioids such as tramadol or morphine are often used then. They can be used in combination with other painkillers. Opioids are often given as an infusion:

• into a vein (intravenous drip, usually in an arm vein), or
• into the spinal region (epidural catheter).

When given through an intravenous drip, the pain medication has an effect throughout the entire body. When using an epidural catheter, pain can be specifically treated in a certain region of the body.

If a fixed amount of medication flows through the drip or the catheter, it is called continuous infusion. Other medications can be added to the infusion if needed. Sometimes it’s possible to regulate the dose of the infusion yourself using a pump. This is known as patient-controlled analgesia (PCA – see below).

Which methods are used near the spine?

One or more painkillers can be given into the epidural space in the back using an epidural catheter. The epidural space is the space around the spinal cord, which is where the spinal nerves that lead to the brain are found.

The medications numb the spinal nerves, stopping them from carrying pain signals to the brain. Epidural catheters can be used for a couple of days. The infusion can deliver painkillers continuously or as needed.

Spinal anesthesia is a bit different. Here, the medication is injected directly into the spinal fluid, causing the lower half of the body to feel numb.

Whenever pain-relieving medication is delivered to the spine area, the area where the skin is pierced could become inflamed. In very rare cases the spinal cord may be injured or bleeding may occur.

How does patient-controlled analgesia (PCA) work?

When using patient-controlled analgesia (PCA), patients can decide when to give themselves pain-relieving medication with the touch of a button. This approach involves inserting a cannula (tube) into a vein, for instance. The cannula is connected to another tube known as a catheter, which leads to a pump that has one or more painkillers in it. When you feel pain, you can give yourself a fixed dose (also called a "bolus dose") of the medication. But the amount of times you can do this is limited so that you can’t use too much (overdose).

Scientific research shows that patients who used PCA had somewhat less pain after surgery and were more satisfied than those who received medication from their nurses or doctors:

• Without PCA: About 65 out of 100 people who had conventional pain treatment were satisfied with the pain relief.
• With PCA: About 84 out of 100 people who used PCA were satisfied with the pain relief.

But those who used PCA ended up taking a higher dose of pain medication overall. For this reason, side effects were more common in this group of patients.

What side effects do painkillers have?

The helpful effects and side effects of painkillers depend on the doses used: High doses may cause more side effects – but low doses might not relieve the pain enough.

Non-opioid painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (paracetamol) or metamizole can cause side effects such as stomach and bowel problems, skin rashes or a drop in blood pressure.

Common side effects of opioids include nausea, vomiting, urinary retention, constipation and itching. They sometimes lead to nightmares or hallucinations too. It is possible to reduce some side effects of opioids by combining them with other painkillers such as NSAIDs.

Some of these problems might not be side effects of medication, but a result of the surgery itself instead. In any case, it’s important to tell your nurse or doctor about them right away – especially if you have trouble breathing.

Can pain be relieved without medication?

Some kinds of pain can be relieved using treatments other than medication. For instance, a surgery wound might hurt if the skin is taut (tight). In that case, simply adjusting the bed or lying in a different position might help. If the bed is too hard, putting a pillow or a piece of foam under that part of the body can relieve the pain.

Other things that can help you cope with pain include relaxation techniques, breathing exercises, distractions, and listening to music. Physiotherapy can help reduce pain too. This may involve exercises in bed, when you get up out of bed and when you walk around. After orthopedic surgery, the affected area is often cooled with cold packs.

What is a Surgical Site Infection?

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.

Symptoms include:

• Redness and pain around the area where you had surgery
• Drainage of cloudy fluid from your surgical wound
• Fever

Can SSIs be treated?

Yes. Most SSIs can be treated with antibiotics. The type of antibiotic given depends on the bacteria (germs) causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection.

What are some of the things that hospitals are doing to prevent SSIs?

To prevent SSIs, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

• Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
• Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.
• If indicated, remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur.
• Wear special hair covers, masks, gowns, and gloves during surgery to keep the surgery area clean.
• When indicated, give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes before the surgery starts and the antibiotics should be stopped within 24 hours after surgery.
• Clean the skin at the site of your surgery with a special soap that kills germs.

What can I do to help prevent SSIs?

Before surgery:

• Tell your doctor about other medical problems you may have. Health problems such as allergies, diabetes, and obesity could affect your surgery and your treatment.
• Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit before your surgery.
• Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection.

At the time of surgery:

• Speak up if someone tries to shave you with a razor before surgery. Ask why you need to be shaved and talk with your surgeon if you have any concerns.

After surgery:

• If you do not see your providers clean their hands, please ask them to do so.
• Family and friends who visit you should not touch the surgical wound or dressings.
• Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, ask them to clean their hands.
• Make sure you understand how to care for your wound before you leave the hospital.
• Always clean your hands before and after caring for your wound.
• Make sure you know who to contact if you have questions or problems after you get home.
• If you have any symptoms of an infection, such as redness and pain at the surgery site, drainage, or fever, call your doctor immediately.

To use this guide you should:

• Talk with the hospital staff about each of the items that are listed in the guide.
• Take the completed guide home with you. It will help you to take care of yourself when you go home.
• Share the guide with your family members and others who want to help you. The guide will help them know how to help take care of you.
• Bring the guide to all of your doctor appointments so the doctor knows what you have been doing to care for yourself since you left the hospital.

When you leave the hospital, there are a lot of things you need to do to take care of yourself. You need to see your doctor, take your medicines, exercise, eat healthy foods, and know whom to call with questions or problems. This guide helps you keep track of all the things you need to do.