Immediate pre-operative period:

• You might not see your Consultant Surgeon on the ward prior to surgery, but will always see him/her following the surgery. If you wish to see him prior to surgery, please ask your nurse.
• You usually see your Consultant Anaesthetist on the ward prior to surgery.
• Most children do not require a ‘pre-med’. However, if your son is feeling very anxious he may be given a ‘pre-med’ 1-2 hours before the operation. This is generally in the form of oral medication.
• Anaesthesia is induced either by gas administered via a mask over the nose and mouth, or by injection. If your son is going to have an injection then ‘magic cream’ – a topical local anaesthetic will be applied to both hands 1-2 hours before the surgery.

Immediate post-operative period:

• You may accompany your child to the anaesthetic room and stay with him until he is asleep.
• The recovery room staff will send for you as soon as your son starts to wake up.
• Generally, your son will be comfortable and sleepy when you see him. However, some children may be disorientated and distressed on waking up. This does not automatically mean that they are in pain. Having a drink of water or milk often pacifies them.
• Children are given a local anaesthetic in the form of a local ‘block’ (e.g.Caudal) as part of the general anaesthesia. The effects of this last for several hours. As this wears off, your son will require further oral analgesia (painkillers) – paracetamol (calpol) and ibuprofen (nurofen) are most commonly used.

First 48 hours Pain control:

• These are the most uncomfortable hours for your son and it is important to give him very regular analgesia – paracetamol and ibuprofen as instructed by the hospital staff, or on the bottle. Do not wait until your son complains of pain.
• Paracetamol can be given every 4-6 hours, a maximum of 4 times in one day. Ibuprofen can be given every 6-8 hours, a maximum of 3 times in one day.
• Paracetamol and ibuprofen can be given together or separately. Some parents prefer to give them separately as this means your son is never longer than 4 hours without some pain relief. It is not necessary to wake your son up to give him any medication if he is asleep; sleep is the best medicine.
• Do not hesitate to give him medicine if he does wake up during the night. Remember that it will take anything from 20-40 minutes for the medicine to take effect and during this time you may need to distract him by whatever method is most effective (reading a story, singing songs, watching a video). You may want to make a chart or record the times you gave him the medication for future reference.

After the first 48 hours:

Bathing:

Your son may have a bath or shower 48 hours after surgery.

Pain control:

• Your son will usually improve very quickly and after the first 48 hours will require less pain medication. Gradually wean him off regular medication, giving it to him immediately if he complains of discomfort, rather than ‘by the clock’.

Mobility and activity:

• Most children will naturally limit their own activity when they feel pain or discomfort. However, playing on toys that need to be straddled like bicycles, rocking horses and many of the activities at play centres, and vigorous activity should be avoided for 2 weeks, or until the discomfort and swelling has completely subsided. It may be a good idea to put these toys away before your son returns home from hospital.
• Infants and toddlers may return to nursery/play groups a week after surgery if the staff are happy to provide the extra attention necessary. Older children may go back to school a week after surgery, but may also need greater supervision, and a further week off competitive sports. Swimming is one activity that can be recommended 7-10 days after surgery if desired.
• There is no need to keep your son in the house whilst he is recuperating. You can take him out and about in the car or in his pushchair – weather permitting.

Potential infection:

If your son develops any of the following symptoms, you should contact your Surgeon or Nasra Ahmed, Complex Surgical Lead Nurse. on 0207 580 4400, bleep 38 (09:00 – 17:00, Monday to) or your GP as this may indicate he has an infection:

• If your son develops a fever.
• If there is recurrent or persistent bleeding, swelling or discharge from the suture line.

Out of hours: Contact our Paediatric Site Practitioner on: 02075804400 ex 10843