What are the recommendations for post-operative care?

Recommendations for Post-Operative Care

Multimodal analgesia that includes regular nonsteroidal anti-inflammatory drugs and paracetamol is strongly recommended as the foundation of post-operative pain management. 1

Pain Management

• Implement a multimodal approach to pain control using scheduled acetaminophen and NSAIDs as first-line agents, with opioids reserved only for breakthrough pain 1, 2
• Consider wound catheters or local abdominal wall blocks to reduce postoperative opioid requirements, although efficacy may vary 1, 3
• Thoracic epidural analgesia should be used only after assessment for sepsis and abnormal coagulation, with appropriate monitoring for hypotension 1
• Avoid routine use of long-acting sedatives preoperatively as they provide no clinical benefit 1

Early Mobilization

• Early mobilization after surgery is strongly recommended to prevent complications such as venous thromboembolism, pulmonary issues, and muscle weakness 1
• Aim for at least 30 minutes of mobilization on the day of surgery and 6 hours per day thereafter 3
• For older patients with frailty, implement patient-oriented rehabilitation to reduce mortality and improve functional outcomes 1

Nutrition and Fluid Management

• Resume a regular diet within 2 hours after surgery when appropriate (particularly after cesarean delivery) 1
• Avoid fluid overloading as it can worsen intestinal edema and prolong ileus 1, 4
• Aim for near-zero fluid balance to improve outcomes 1

Venous Thromboembolism (VTE) Prevention

• Assess patients with a validated tool for VTE risk on admission and throughout hospital stay 1
• Use mechanical prophylaxis (pneumatic compression stockings) for all patients undergoing surgery 1
• For high-risk patients, combine pharmacological with mechanical prophylaxis 1
• Continue VTE risk assessment and appropriate prophylaxis daily during the postoperative period 1

Preventing and Managing Postoperative Ileus

• Remove nasogastric tubes as early as possible as routine use does not improve outcomes 1, 4
• Consider using prokinetic agents, bisacodyl, and magnesium oxide to promote bowel function 5, 4
• Chewing gum after surgery may help stimulate bowel function through cephalic-vagal stimulation 4

Preventing and Managing Delirium

• Patients over 65 years of age should receive regular postoperative delirium screening 1
• Implement non-pharmaceutical interventions such as regular orientation, sleep hygiene approaches, and cognitive stimulation to prevent delirium 1
• Minimize medication triggers that can precipitate delirium 1

Wound Care and Infection Prevention

• Antimicrobial prophylaxis should be used in a single-dose manner initiated 30-60 minutes before skin incision 1
• For contaminated or potentially contaminated surgery, consider extending prophylactic antibiotics for 24 hours postoperatively 6
• In surgery where infection would be particularly devastating (e.g., open-heart surgery, prosthetic arthroplasty), prophylactic antibiotics may be continued for 3-5 days 6

Postoperative Monitoring and Level of Care

• Establish protocols for determining appropriate location for postoperative care based on validated preoperative risk scores, surgical impact, physiological stability, and ongoing therapeutic requirements 1
• Consider ICU admission for high-risk emergency laparotomy patients to reduce mortality and length of stay 1
• Monitor for persistent hypothermia and use forced-air warming blankets, raised ambient room temperature, and warming of irrigation and IV fluids to prevent it 1

Special Considerations

• For cesarean delivery, early feeding within 2 hours is strongly recommended 1
• Maintain tight control of capillary blood glucose in the postoperative period 1
• Remove urinary catheters immediately after cesarean delivery if placed during surgery 1

Discharge Planning

• Provide standardized written discharge instructions to facilitate discharge counseling 1
• For patients undergoing laparoscopic myomectomy, advise avoiding heavy lifting, strenuous exercise, and sexual activity for at least 2-3 weeks 3
• Schedule follow-up appointments 2-4 weeks after surgery to assess healing and recovery 3