ISALA

Weergave

Om u de beste leesbaarheid te bieden, kunt u hier het lettertype en de achtergrondkleur naar wens aanpassen.

Lettertype


Achtergrond

Anesthesia (EN)

Verdoving/Anesthesie

This brochure provides information on the various forms of anesthesia and pain management during and after surgery.

Preparation for your surgery

You will be having surgery in the near future. The specialist treating you has informed you on this. A form of anesthesia will be required during the operation. The anesthesiologist is the physician specialized in administering anesthesia. He/she is responsible for ensuring effective and safe anesthesia and for other care surrounding your surgery.

Preoperative examination

You and your attending physician have discussed the fact that you will be undergoing a surgical procedure. The secretary of the doctor who treated you, will discuss with you how the appointment can be made at the outpatient clinic 'Preoperatief onderzoek'. This is an examination that takes place prior to surgery. You may already have attended a preoperative consultation by the time you read this brochure. In that case, you can skip the information about the preoperative examination.

Appointment for preoperative examination

It is important that you bring the following items with you when you come to the hospital for your preoperative examination:

  • a valid identity document (this is necessary in order to register at the registration kiosks)
  • a current list issued by your pharmacy stating of all of the medications you use.
  • a completed preoperative questionnaire (front and back).

In the event that you are unable to attend your appointment, we urge you to cancel it as soon as possible so that we can see another patient in your place.

During the preoperative examination, you will have consultations with a pharmacy technician (if you are on medication), a nurse and an anesthesiologist. These consultations together will take about an hour.

Consultation with the pharmacy technician (if you are on medication)

The pharmacy technician will go over the list of medications you take at home in order to determine which medications you actually use. Remember to mention any over-the-counter medication purchased from the drugstore. This information will be entered into Isala's computer system for the purpose of medication safety. This ensures that the anesthesiologist always has an up-to-date medication summary during consultations. If any adjustments are made to your medication after the preoperative examination (by the anesthesiologist), please call 038 424 25 21 to notify the pharmacy technician so that he/she can enter the changes in your patient record.

Consultation with the nurse

The nurse will discuss the agreements made with you concerning preparations for surgery and follow-up care. During the consultation, she will go over a number of questions with you, which are important for the nursing ward. She will also ask you about your situation at home and the expected follow-up care. In addition, she will tell you about any medical devices you may need and where you can obtain them.

Consultation with the anesthesiologist

Anesthesia involves more than just administering anesthetics or putting you to sleep. When you undergo surgery, this affects important bodily functions such as circulation and respiration (breathing). The anesthesiologist uses special equipment to monitor these functions and treat and regulate any changes that may occur. This way he/she will ensure that you undergo the procedure safely.

It is very important that he/she is fully informed about your state of health, so that additional measures can be taken before or during your procedure if necessary. During the preoperative examination, he/she will therefore ask you whether you have had surgery before and will also discuss the medication with you. He/she will also examine your heart and lungs. Sometimes additional examinations or tests may be necessary before you can undergo surgery. The anesthesiologist will discuss this with you.

If you have any concerns or questions about the anesthesia, you can bring them up during this consultation. The anesthesiologist may be able to reassure you and answer your questions. The anesthesiologist who cares for you during your surgery might not be the same anesthesiologist who performs your preoperative examination. However, all the necessary information for anesthesia will be available in the operating room during your surgery. So the anesthesiologist on duty will always be aware of your medical details.

If you use blood thinners, it is important that you mention this during your consultations with the pharmacy technician and the anesthesiologist. This will be discussed with the nurse and the anesthesiologist. If you are registered with the Isala Thrombosis Service, you do not need to do anything. They will contact you. They will discuss the protocol concerning blood thinners and surgery with you.

If you are registered with a different thrombosis service, you must contact this service yourself in order to pass on the date of your surgery. Your thrombosis service will then inform Isala, after which the Isala Thrombosis Service will contact you.

Your preparations

To ensure that the anesthesia proceeds as effectively and safely as possible, it is very important that you make the necessary preparations. The most important instructions and agreements are listed below.

Fasting before surgery

In order to prevent serious complications such as pneumonia, you must fast before surgery. This applies to children as well as adults who are about to undergo surgery. We explicitly ask parents and guardians to be alert to this.

If you have not fasted, your surgery cannot proceed and will be postponed. The department may still charge you for your surgery in this case.

 

Important
You must fast before surgery.
Fasting means:
  • You may only have a light breakfast up to 6 hours before admission time.
    • For example: 2 rusks/or two crackers/1 slice of bread with jam, infant formula or parenteral nutrition. It is very important that your stomach is empty during your surgery. Otherwise there is a chance that your stomach contents will enter your lungs. This can cause serious pneumonia.
  • Your baby may drink breast milk up to 4 hours before admission time.
  • You may only drink clear fluids up to 2 hours before admission time
    • such as: tea, water or clear apple juice/lemonade (no dairy products or bouillon/soup), unless the anesthesiologist has made other arrangements with you.

Example
You are expected at the hospital at 15:00. This is referred to as the admission time. In this case, you may not eat anything after 9:00, and you may not drink anything after 13:00.

Are you being admitted the day before your surgery?

In that case you do not have to fast before coming to the hospital. The nurse in the ward will let you know the exact times.

Medication

You can continue to take your medication as usual, unless the physician has made other arrangements with you. You may be asked to stop taking blood thinners for several days before your surgery. The anesthesiologist or the Isala Thrombosis Service will provide instructions on this.

No smoking

It is advisable not to smoke during the hours before your surgery. The airways of smokers are often irritated and therefore more prone to infections. In addition, coughing can be very painful after surgery. Smoking also has a negative effect on wound healing.

Cosmetics

We explicitly request that you do not wear any body lotion, makeup or nail polish on the day of your surgery. Do you wear acrylic nails? Then remove the acrylic nail from your left index finger. If you are being operated on your left arm, remove the acrylic nail from your right index finger.

Jewelery and assistive devices

Shortly before going to the operating room, you will be given a hospital gown to wear. Please remove any jewelery or piercings, such as a watch, rings, earrings or tongue piercing. It is best to leave these items at home or put them in a safe place in consultation with the nurse. Eyeglasses and dentures should also be left in the nursing ward. Hearing aids do not always have to be removed.

Our preparations

On the day you are admitted to the hospital, you will receive a short questionnaire. Write down any changes that have occurred with regard to your state of health and/or use of medication since the preoperative examination (the consultation with the anesthesiologist). If necessary, the anesthesiologist will contact you or visit you prior to surgery.

Prior to surgery, the nurse may perform a few preparatory procedures. For example, if your bowels need to be empty, you will be given laxatives. The nurse may give you a tablet and/or injection to prepare you for anesthesia. This is called premedication and can make you feel drowsy. You will be given pain medication before your surgery. This will have time to take effect during your surgery so that you feel less pain afterwards.

To the operating room

The nurse will wheel you to the operating room in your hospital bed. When you arrive, you will see the anesthesiologist and the anesthesiologist assistant. You will be connected to monitoring equipment. Stickers will be placed on your chest to measure your heart rate, and a clip will be placed on your finger to measure your blood oxygen level. Your blood pressure will be measured on your arm. You will also have an intravenous catheter (IV) inserted in your arm, so that the anesthesiologist can administer medication during surgery if necessary.

Anesthesia during surgery

There are different forms of anesthesia. There is a difference between general anesthesia and regional anesthesia.

General anesthesia

For operations performed under general anesthesia, the anesthesiologist will administer the anesthetics intravenously. These anesthetics are fast-acting. You will be completely unconscious and will temporarily be in a deep sleep (anesthetized). In some cases, general anesthesia is combined with neuraxial (spinal or epidural) anesthesia or plexus anesthesia.

Regional anesthesia

Some surgical procedures can be performed under regional anesthesia. In that case, only part of your body will be anesthetized. This can be done in several ways:

  • Neuraxial (spinal or epidural) anesthesia can be used for surgery on the lower half of the body.
  • For surgery on the arm or hand, only the arm can be anesthetized by means of an injection in the armpit or neck. This is called plexus anesthesia.
  • For surgery on a leg or foot, it may be possible to anesthetize only the leg by means of injections in the buttock and/or the leg. Sometimes regional anesthesia is combined with a sedative, so that you are drowsy and relaxed during the procedure. This is referred to as sedation.

General anesthesia

In the case of general anesthesia, your whole body is anesthetized. Because general anesthesia renders you temporarily unconscious, you will not feel anything during the operation and you will not remember it afterwards. While you are under anesthesia, the anesthesiologist and the anesthesiologist assistant will monitor your respiration (breathing), heart rate and circulation. Because anesthesia slows down respiration, this bodily function will be monitored and taken over by means of artificial respiration if necessary.

Before and during surgery

You will be connected to monitoring equipment in the preparation area (holding) of the surgery department. You will also have an intravenous catheter inserted into your arm, through which fluids will be administered. In the operating room, the anesthesiologist will administer the anesthetics intravenously. You will then fall into a deep sleep within about 30 seconds.

For some operations, it may be necessary to insert a breathing tube into your throat. The anesthesiologist will insert this breathing tube before the operation begins. You will not notice the breathing tube being inserted because you will already be under anesthesia.

The anesthesiologist and/or the anesthesiologist assistant will keep a close eye on you during your surgery. The anesthesiologist will monitor and regulate your body's functions during the operation. The monitoring equipment will record precisely how your body is responding to the operation. The anesthesiologist can adjust your respiration and circulation if necessary. He/she will also administer medication to manage or maintain the anesthesia.

After your surgery

After your surgery, the anesthesiologist and the anesthesiologist assistant will bring you to the recovery room. This is a separate room near the operating room where patients recover from anesthesia immediately after surgery. Specialized nurses will monitor your condition constantly, provide everything you need and administer any medications prescribed. The IV will remain in place for some time, depending on your surgery and your physical condition. The IV can be used to administer fluids and medication. You will be allowed to move the arm with the IV.

Visitors are not permitted in the recovery room. However, exceptions may be made. The recovery nurse will determine whether or not it is possible to receive visitors. 
You may have a small tube in your nose while you are in the recovery room. This is used to administer extra oxygen or to keep your stomach empty. A small tube to the bladder, called a urinary catheter, may be inserted to ensure that urine drains freely. All of this may look rather concerning, but will aid in your recovery considerably.

A nurse from your nursing ward will come and get you once:

  • the anesthetic has worn off sufficiently
  • your blood pressure and respiration are stable
  • pain and/or nausea are under control.

After waking up, you may have sore muscles, a sore throat and sore joints. This is because you will have been lying in the same position throughout your surgery. You may also feel nauseated. These symptoms are temporary and will resolve on their own. Remember that your body is recovering from an unusual situation. The anesthetics used will wear off within a day. However, your body will need several days to weeks to recovery fully.

Intensive care

After your surgery, you may need to spend some time in the Intensive Care Unit where you can be monitored closely. Your attending physician will generally already know this prior to surgery, and will therefore discuss this with you ahead of time.

Pain

When you wake up from anesthesia, you may feel pain around the surgical wound. How the nurses will respond to your pain symptoms, if applicable, is described under Pain management and pain registration.

Side effects of anesthesia

If you have had general anesthesia, you may feel drowsy and doze off from time to time shortly after surgery. That is completely normal. You may also feel nauseated and you may need to vomit. Unfortunately, it is not always possible to prevent nausea after a surgical procedure. If necessary, you can ask the nurse for a painkiller or anti-nausea medication.

The breathing tube that was in your throat during surgery may make your throat feel sore. This will usually get better on its own within a few days.

Many people are thirsty after surgery. If you are allowed to drink, do so carefully. If you are not allowed to drink, the nurse can moisten your lips to alleviate the worst of your thirst.

Complications of anesthesia

Anesthesia is very safe nowadays. This is thanks to improvements in monitoring equipment, the availability of modern drugs and good training for anesthesiologists and anesthesiologist assistants.

However, no matter how much care is taken, complications cannot always be prevented. Examples of complications are allergic reactions to medication and damage to teeth while inserting the breathing tube. Another possible complication is tingling and loss of strength resulting from a pinched nerve in the arm or leg after lying in an awkward position during surgery.

The development of serious complications as a result of anesthesia is virtually always attributable to an emergency or associated with your state of health before surgery. You can ask the anesthesiologist whether anesthesia is associated with any particular risks in your case.

Going home

After having anesthesia, you may experience a temporary delay in your reactions. If you are allowed to go home on the day of your surgery, you must ensure that you do not spend the first night after being discharged from hospital alone. In addition, you may not drive yourself home, and someone must accompany you. You should also refrain from operating dangerous machinery and making important decisions that day.

Important

Make sure you have enough over-the-counter painkillers, such as paracetamol (acetaminophen), ibuprofen or diclofenac, at homee.

Take it easy for the first 24 hours after surgery. It is best to consume easily digestible foods and drinks. Carefully follow the instructions you receive from the physician who performed your surgery.

It is completely normal not to feel fit for some time after surgery. This is related to the anesthesia as well as the stressful experience of surgery. The body has to recover at its own pace, and this takes time.

Neuraxial anesthesia

There are some misconceptions about neuraxial anesthesia. Many people think it is very painful. However, most patients who receive this form of anesthesia find it to be less painful than expected. The only part they find painful is when the needle punctures the skin. This is a similar sensation to having blood taken.
There are several types of neuraxial anesthesia. The most common are:

  • spinal anesthesia (or spinal block)
  • epidural anesthesia.

Spinal anesthesia

The most common form of neuraxial anesthesia is the spinal block or spinal anesthesia. This injection is used for surgery below the umbilicus (belly button) area. You will then be fully anesthetized from the belly button down. However, you will remain conscious. If you wish, you can usually be given a sedative so that you are not ‘fully aware’ during the surgery.

Procedure

The anesthesiologist will ask you to sit down or lie on your side and to round your back. The anesthesiologist will insert a very fine needle just through the spinal meninges to inject the anesthetic. Once the anesthetic has been injected, your legs will feel warm followed by a tingling sensation. Later they will become numb and limp, as will the rest of your lower body.

Occasionally spinal anesthesia may not be sufficiently effective. In some cases, the anesthesiologist can administer some additional anesthetic. In other cases it is better to opt for a different form of anesthesia, such as general anesthesia. The anesthesiologist will discuss this with you.

After your surgery

After your surgery, the anesthesiologist and the anesthesiologist assistant will bring you to the recovery room. This is a separate room near the operating room, where patients recover from anesthesia immediately after surgery. Specialized nurses will monitor your condition constantly, provide everything you need and administer any medications prescribed. The IV will remain in place for some time. The IV can be used to administer fluids and medication. You will be allowed to move the arm with the IV.

Visitors are not permitted in the recovery room. However, exceptions may be made. The recovery nurse will determine whether or not it is possible to receive visitors.

You will be brought back to the nursing ward after about an hour. Depending on the medication used, it can take one to three hours for the anesthetic to wear off completely. As it wears off, you will feel a tingling sensation in your legs. The ability to move your legs will return first, and the feeling in your legs will return last. Once the anesthetic has worn off completely, you will regain normal muscle strength and muscle control.

Nausea may occur after spinal anesthesia, although less frequently than after general anesthesia. You can ask for anti-nausea medication if necessary.

Pain

You may feel pain once the anesthetic has worn off. How the nurses will respond to your pain symptoms, if applicable, is described under Pain management and pain registration.

Side effects and complications

A possible side effect of spinal anesthesia is low blood pressure. The anesthesiologist is prepared for this and will take measures accordingly. Sometimes the anesthetized area can extend somewhat higher than the belly button. If this happens, you will notice a tingling sensation in your hands. Occasionally, breathing may be impaired somewhat. If this happens to you, the anesthesiologist will administer extra oxygen, which usually resolves the problem.

Spinal anesthesia also blocks normal bladder function. As a result you may find it difficult or impossible to urinate. If short-acting anesthetics are used (as in the case of a short outpatient procedure), your bladder function will usually be restored before your bladder is too full. It is therefore important to urinate before surgery. Occasionally it may be necessary to empty the bladder with a catheter.

A urinary catheter is always inserted when longer-acting anesthetics are used. You will hardly feel this, because it is done after the administration of the spinal anesthetic, as a result of which the area will be anesthetized.

In some cases, the injection site on the back may be sore or sensitive. This will get better on its own over time. Pain in other areas of your back may be caused by the position you were in during surgery. This pain will usually disappear within a few days.

Headaches are another possible side effect of spinal anesthesia. They occur in just 0.3 percent of patients aged 15 to 25. The older you are than 25, the smaller your chance of developing headaches. These headaches are different to ‘normal’ headaches. The pain subsides when affected patients lie down, and worsens when they sit up. These headaches can occur immediately after the procedure, or may take more than 24 hours to develop. Usually these headaches will clear up on their own within a week. If the symptoms are so severe that you need to stay in bed, you should contact the anesthesiologist.

Going home

After having spinal anesthesia, you may experience a temporary delay in your reactions. If you are allowed to go home on the day of your surgery, you must ensure that you do not spend the first night after being discharged from hospital alone.

In addition, you may not drive yourself home, and someone must accompany you. You should also refrain from operating dangerous machinery and making important decisions that day.

Important

Take it easy for the first 24 hours after surgery. It is best to consume easily digestible foods and drinks.

It is completely normal not to feel fit for some time after surgery. This is related to the anesthesia as well as the stressful experience of surgery. The body has to recover at its own pace, and this takes time.

Epidural anesthesia

Patients who have surgery on their abdomen or chest cavity may experience a lot of pain afterwards. In those cases, morphine often provides insufficient pain relief or is associated with side effects such as drowsiness and nausea. Therefore, the anesthesiologist will usually choose to use a combination of epidural anesthesia and general anesthesia for such major surgery.

By means of the epidural technique, the nerves to the wound area are anesthetized during and after surgery. Epidural anesthesia involves the insertion of a thin tube into the back, placed just outside the spinal meninges. Medication can be administered by means of a small pump connected to this tube. This makes it possible to maintain the anesthesia for days at a time. The nerve roots of the wound area will be anesthetized.

Procedure

You will be given an IV and connected to the monitoring equipment. You will then have to sit down and the anesthesiologist will ask you to round your back. Your skin will be anesthetized properly first, so that you do not really feel the epidural injection itself. The anesthesia itself may produce a brief burning sensation.

Afterwards, the anesthesiologist will use a special needle to find the epidural space. This is the space between the inside of the spinal canal and the dura mater. This requires great precision because the needle must not puncture the spinal meninges. It may take the anesthesiologist a few minutes to find the space. Occasionally multiple attempts will be needed to insert the needle into the right place. Because your back will be thoroughly anesthetized, you will only feel a slight pushing or pressure sensation in your back.

Once the needle is in place, the anesthesiologist will feed a very thin tube (epidural catheter) through it. You may feel a kind of electric shock at this point. Although this is harmless, you should let the anesthesiologist know if this happens. Once the thin tube is in place, the needle will be removed and everything will be secured with tape. Afterwards you will lie back down on your back and be put to sleep. The tube is so thin that you will hardly notice it while lying down. In most cases an epidural will provide excellent pain relief with few side effects.

Because epidural anesthesia disrupts normal bladder function, you will have a urinary catheter inserted. This urinary catheter will remain in place while the epidural is in use.

After your surgery

After your surgery, a pump will be used to administer anesthetic continuously by means of the epidural catheter. This pump will also be brought to the nursing ward and will usually be used for about 48 hours. The pump can be used longer if necessary. You will be monitored regularly by staff from the Acute Pain Service. Contrary to spinal anesthesia, epidural anesthesia will not make your legs completely limp and you will be able to move them. However, you may experience some loss of strength in your legs.

Side effects and complications

One of the medications administered by means of the epidural catheter can cause itching. In that case, the solution used will usually be adjusted. Bleeding or infection in the back can occur sporadically. This can produce the following symptoms:

  • pain in the back
  • numbness in an area where you previously had good sensation
  • loss of strength in muscles that you were able to use well previously.

If you experience any of these symptoms, you should mention this immediately. The anesthesiologist can assess what is wrong and what needs to be done.

Plexus anesthesia

An arm or leg can be anesthetized by temporarily blocking the network of nerves (plexus) that runs to your arm or leg. This is done by injecting an anesthetic around the nerves, such as those in the armpit or neck.

Procedure

You will be given an IV so that medication can be administered during surgery if necessary.

Once you have been connected to the monitoring equipment, the anesthesiologist will insert a needle at the site where the nerves run to the area that needs to be anesthetized. The nerve is stimulated using a small electric current. If the needle is in the vicinity of the nerve, your arm/leg will move involuntarily. By looking at which muscles move, the anesthesiologist can tell at which nerve the point of the needle is located and whether he/she needs to anesthetize that nerve.

Ultrasound is used increasingly to make insertion of the needle easier and more precise. It is important that you lie still while the needle is being inserted. Once the needle is in the right place, the anesthesiologist will inject the anesthetic. Soon afterwards, you will notice a tingling and warm sensation in your arm or leg. This feeling will later disappear and you will no longer be able to move your arm or leg. It takes about 15 to 30 minutes until the full effect of the anesthetic is achieved.

You will stay awake during surgery. If you prefer to sleep, you can request a sedative. You will not see the surgery being performed, as the affected area will be covered with surgical drapes. Occasionally, the anesthetic may not be sufficiently effective for you. Sometimes the anesthesiologist can administer some additional anesthetic. In exceptional cases it is better to opt for a different form of anesthesia, such as general anesthesia. The anesthesiologist will discuss this with you.

For surgery on the shoulder, plexus anesthesia is usually applied with an injection in the throat or neck area. This is done mainly for pain relief after surgery. You will also be given a general anesthetic for the surgery.

After your surgery

After your surgery, the anesthesiologist and the anesthesiologist assistant will bring you to the recovery room. This is a separate room near the operating room, where patients recover from anesthesia immediately after surgery. Specialized nurses will monitor your condition constantly, provide everything you need and administer any medications prescribed. The IV will sometimes remain in place for some time. The IV can be used to administer fluids and medication. You will be allowed to move the arm with the IV.

Visitors are not permitted in the recovery room. However, exceptions may be made. The recovery nurse will determine whether or not it is possible to receive visitors.

You will be able to return to the nursing ward shortly after surgery. Depending on the medication used, it can take two to six hours for the anesthetic to wear off completely. However, sometimes it can take 12 to 24 hours. As it wears off, you will feel a tingling sensation in your anesthetized arm. The ability to move your arm will return first, and the feeling in your arm will return last. Once the anesthetic has worn off completely, you will regain normal muscle strength and muscle control.

Following plexus anesthesia of an arm, you do not have to remain in hospital until the anesthetic has worn off. Whether and when you are allowed to go home depends on what surgery you have had. Your arm will remain in a sling while it is anesthetized. You will be unable to stand or walk on your leg while it is anesthetized. In that case you will need a wheelchair or crutches.

Pain

You may feel pain once the anesthetic has worn off. How the nurses will respond to your pain symptoms, if applicable, is described under Pain management and pain registration.

Side effects and complications

You may have a tingling sensation in your arm and hand for some time after the anesthetic has worn off. This is caused by irritation of the nerves (by the injection) or by the medication used. In most cases, the tingling will disappear on its own in a matter of weeks or months.

Although the anesthetic is injected around the nerve, it finds its way into the bloodstream after which it is broken down by your body. If a large amount of anesthetic winds up in your blood, you may experience a metallic taste in your mouth, tingling around the mouth, drowsiness or tinnitus (ringing in your ears). In extremely rare cases, this can lead to arrhythmia (abnormal heart rhythm) or loss of consciousness. Because you will be closely monitored during and after the procedure, such complications can be treated effectively.

Going home

After having anesthesia, you may experience a temporary delay in your reactions. If you are allowed to go home on the day of your surgery, you must ensure that you do not spend the first night after being discharged from hospital alone. In addition, you may not drive yourself home, and someone must accompany you. You should also refrain from operating dangerous machinery and making important decisions that day.

Important

Take it easy for the first 24 hours after surgery. It is best to consume easily digestible foods and drinks.

It is completely normal not to feel fit for some time after surgery. This is related to the anesthesia as well as the stressful experience of surgery. The body has to recover at its own pace, and this takes time.

Sedation

Sometimes local anesthesia is combined with sedation. The purpose of sedation is to make you feel drowsy, so that you are less 'aware' of the surgery. This drowsiness occurs immediately after the sedative is administered. How drowsy you will feel cannot be predicted beforehand. But you will be more relaxed during surgery even if you do not fall asleep.

Procedure

The anesthesiologist will administer the sedative by means of the IV in your arm or hand. The medication will usually act quickly.

Side effects of sedation

Sedation can cause shallow breathing. You will be given extra oxygen if necessary.

Pain management and pain registration

After surgery, you may be confronted with pain. Pain is an unpleasant symptom or side effect of many diseases and of surgery. Good pain relief is important because it accelerates recovery. Inadequate pain relief can inhibit effective coughing, disrupt sleep and delay your recovery. However, too much pain medication is associated with a risk of side effects. Because pain varies from patient to patient, good pain management requires a customized approach. In Isala’s nursing wards pain is registered according to a pain score.

Pain score

To gain a clear impression of how much pain you are experiencing and whether the pain-relieving measures are effective enough, the nurse will ask you how much pain you are feeling several times a day. You can indicate your pain in two different ways: with a score on the NRS scale, or a picture on the VAS scale.

With a score on the NRS scale

NRS stands for numeric rating scale, and concerns a score on a scale of 0 (no pain) to 10 (the worst possible pain you can imagine). When determining a pain score, it is best to think back to the pain you had before and compare it to how you are feeling now. A pain score of 4 or less is considered acceptable. You can never give an incorrect score. After all, it is about the pain you experience.

With a picture on the VAS scale

You can also use a ruler with different faces. VAS stands for visual analog scale. The left end of the ruler is labeled ‘no pain’ and the right end ‘the worst possible pain I can imagine’.

It is possible for you to feel pain in more than one area of your body. Examples are pain as a result of surgery or treatment, and pain as a result of lying in bed in an uncomfortable position or for a long period of time. The idea is that you express the worst pain you feel in the form of a score or a picture. Any information you can give us about your pain perception will enable us to treat you more effectively.

Based on your pain score, the nurse may or may not adjust your pain medication. If anything is unclear, he/she will consult with the doctor. Please note that you will not be completely pain free, but the pain should be bearable.

Different methods of pain management

The anesthesiologist has made an agreement with you about which form of pain relief you will be given. The three forms are described below.

Medication

While you are in hospital, you may receive pain relief in the form of tablets, suppositories or by means of an IV. Your basic pain relief will consist of paracetamol (acetaminophen), in combination with diclofenac if necessary. This can be supplemented with a stronger medication or other forms of pain relief.

PCA pump

PCA stands for Patient-controlled Analgesia. A PCA enables you to give yourself small amounts of pain medication so that you do not have to wait for the nurse. If you feel too much pain, you can press the green button. You will notice the effect after a short while. If this is not enough, you can press the green button again. You can repeat this until the pain is at an acceptable level for you. You do not have to worry about giving yourself too much pain medication because the concentration and amount are calculated carefully.
You can use the PCA pump for several days. A staff member from the Acute Pain Service will visit you regularly while you are using a PCA pump. You can also ask him/her any questions you may have.

Epidural

Epidural pain management involves the insertion of a very thin tube into your back. Pain medication can then be administered through this tube.

Contact

This information forms a supplement to the verbal information you receive from your attending physician and/or anesthesiologist. If you have any questions or would like an explanation, the anesthesiologist or the nurse will be happy to assist you. If you wish, you can also phone the outpatient clinic 'Preoperatief onderzoek' at 038 424 21 39. For questions on the procedure and information about the date of your surgery, please phone the referring outpatient clinic.


20 oktober 2016 8010 Nee Nee

Stuur door

Door onderstaande invulvelden in te vullen, stuurt u deze informatie gemakkelijk door.
Aan emailadres*
   
Uw naam Uw emailadres*
   
Bericht