PATIENT INFO

Nil per os: What does this mean?

To avoid anaesthetic complications it is required that you should NOT EAT OR DRINK SEVEN HOURS PRIOR TO YOUR SURGERY. Practically this entails that should your surgery be scheduled in the morning you should not eat after midnight and if scheduled in the afternoon, you can have a LIGHT breakfast before 06h00 hours on the morning of the procedure.

Admission (check in):

You have to report to the hospital reception (Stellenbosch Mediclinic) at least three hours prior to your surgery. Dr Prinsloo mostly makes use of an afternoon theatre slate, therefore admission will be at 10h00 (otherwise at 07h00 for a morning slate). It is important to arrive on time as late arrival may lead to delays or even cancellation of your surgery. After registration you will be admitted in the hospital ward. A nurse will check you into the ward and will ask you a list of health related questions and monitor your pulse, blood pressure and temperature as a routine procedure pre-operative. You will then be asked to change into a theatre gown.

Anaesthesia

Except in unusual circumstances the anaesthetist will come and consult with you in the ward pre-operatively for evaluation and to discuss the details of the anaesthetic. Please feel free to ask him all your anaesthetic related questions and it is very important to mention any previous anaesthetic related problems i.e. nausea, difficult intubation, breathing difficulty post-anaesthetic or any other related problems as for example a family history of porfiria. (NB: ANYTHING MIGHT BE IMPORTANT).

You will then be taken to the theatre waiting area in your bed plus minus 30 minutes prior to your surgery.

Very important:

Probably the most important part of your preparation for theatre, is giving consent for the planned surgical procedure and associated with that MARKING OF THE TO BE OPERATED SHOULDER LIMB WITH A BLACK CROSS CLEARLY VISIBLE WITH A PERMANENT MARKER.

Surgical procedure:

On arrival in the theatre complex you will be checked in for a second time before being wheeled into the operating room. It is very important to note that you will be asked the same questions on several occasions and the surgical concent and marking of the shoulder will be checked and correlated. Upon arrival in the theatre room you will be transferred from your bed to the operating table. A general anaesthetic will be administered by the anaesthetist after which you will be looked after by a highly skilled professional (anaesthetist) with modern monitoring equipment for the duration of the procedure. A new addition to the monitoring in Dr Prinsloo’s theatre is monitoring of the brain oxygenation in the so called “beach chair” position which also makes the surgery much safer.

The surgical team consists of the surgeon (Dr Prinsloo), surgical assistant (scrub sister), two or three nurses assisting the anaesthetist and scrub sister and a technical representative of the surgical company supplying instruments for the surgery as well as the assistant doctor for the surgeon (Dr Prinsloo).

Duration of the surgery:

Although it is very difficult to always accurately access the duration of a specific surgical procedure, Dr Prinsloo will try to give an estimate of the duration. It is however very important to remember that it is only an estimate and surgery times may differ often.

After surgery:

You will wake up from the anaesthetic in the theatre recovery room. A nurse will be assigned to monitor and assist you during this process. When you are awake and stable with good pain control, you will transferred back to the ward.

Sling:

A sling may be supplied in the theatre in exceptional circumstances, but mostly it will be supplied post-surgery by the physiotherapist in the ward. The physiotherapist will explain the sling, how to apply and wear best as possible. The duration for wearing of the sling will differ from every surgical procedure and will be discussed in the specific surgical procedure section.

Post-operative pain:

Effective control of pain is very important after any surgical procedure especially 12 hours post surgery. The most effective way of controlling pain in this period is, if at all possible, the use of local anaesthetic infiltration or regional blocks (the latter entails injection of local anaesthetic in the area of the nerves that supply the pain sensation in the area where the surgery was performed).

Dr Prinsloo makes use of local infiltration with local anaesthetic in the area of surgery and in association with this, in most cases, the use of local anaesthetic as a continuous infiltration directly in the area of the surgery. This is achieved by means of a specific catheter inserted in the surgical site with a calibrated rubber balloon filled with local anaesthetic that is administering a specific dose over time for proper pain relief.

This is a very effective way of pain relief and also very safe with a very low complication rate. The only complication that might arise is a possible allergy to the local anaesthetic (very rare) or possible problems with the removal of the catheter (which is also very uncommon).

Upon discharge you will mostly be issued with a combination of NSAID drug (if safe) and an analgesic for pain relief at home. You will also be advised on how much movement is allowed for your shoulder to prevent serious post-operative pain.

Follow-up consultation:

Upon discharge you will be advised on a date for a follow-up appointment. This appointment mostly will be made by the ward staff with Dr Prinsloo’s rooms. Mostly an appointment will be scheduled within one or two weeks after your date of surgery. In the unlikely event that you did not receive a date for follow-up, please contact the rooms for an appointment upon discharge.

Post surgery problems, complications or questions:

Should you experience any of the above, please feel free to contact Dr Prinsloo’s rooms or him personally. It is very important to remember that any surgical procedure can develop a complication. It is therefore very important that the earlier a problem can be detected and treated, the less the impact will be.

PLEASE FEEL FREE TO CONTACT DR PRINSLOO IF YOU FEEL THAT ANYTHING OUT OF THE ORDINARY IS DEVELOPING AFTER YOUR SURGERY.

Depending of the type of surgery, you can expect to have one bigger incision (like in the case of a replacement surgery), multiple smaller incisions (like in the case of arthroscopic surgery), or a combination of these.

After surgery the wound will immediately be covered with fluid-absorbing dressing that will either be removed the next day (in the case of an overnight stay) or after three to four hours (in the case of a day procedure).

The wound will then be covered with a water-tight post-operative dressing. You are allowed to shower with this dressing.

This dressing stays on for seven to ten days, after which it can be removed and the wound can stay open and get wet. The dressing can be changed should it get wet and soggy within the first two to three days.

It is very important to note, however, that any wound seepage after day five post-surgery is often not normal. In this case, please contact your treating physician as soon as possible.

The sutures used is absorbable and do not need to be removed. These will either dissolve under the skin or fall out after three to four weeks. After seven to ten days the sutures can also can also get wet.