Enhanced recovery after idiopathic scoliosis surgery for teenagers

This information resource will help you understand what to expect with your operation and how you can play an active part in your recovery. The aim of the enhanced recovery programme is to get you back to full health as quickly as possible after your scoliosis surgery. It is used after many different operations and more information can be found at ERAS Society.

After surgery

After any type of surgery, the earlier we get you out of bed, exercising, eating and drinking the quicker your recovery will be, and the less likely you are to develop complications with the operation or your general health.

Outcomes from surgery have also been improved by giving you, and your family, as much information as possible before the operation so you know what to expect. Please take time to read all the other resources about adolescent idiopathic scoliosis surgery on our library.

Enhanced recovery is about giving you the best care possible, which in turn, can lead to a faster recovery.

Pre-op assessment and consent appointments

As your operation date gets nearer, you will be seen in a pre-operative assessment and by the consultant surgeon performing the operation. The spinal nursing team will explain all aspects of the care you will receive, from the day of admission, through to follow-up arrangements. Please bring all your questions to this appointment.

You will also get to meet other members of the team involved in your care such as the physiotherapist, the ward doctor, the respiratory nurse, the pain management nurse and a consultant anaesthetist.

Eating and drinking before surgery

On the day before your surgery you will be able to eat and drink as normal. You can drink clear fluids up until your time for surgery, and can eat for up to 6 hours before your operation. This is normally around 2.30am on the day of your surgery.

We will also ask you to drink a special carbohydrate drink the night before and on the morning of your operation. Even though you may think you are simply sleeping all day, your body is actually working hard during the operation and so needs to use a lot of energy. You cannot provide this energy because you need to have an empty stomach before and during the surgery. These carbohydrate drinks help decrease your chance of infection, improve wound healing and aid your overall recovery.

After your surgery

Eating and drinking

When you wake up after your operation you are often very thirsty and you want to drink lots. Please start with sips and increase the amount you drink slowly because if your stomach gets full very quickly, you may be sick.

On the day of your operation, we will let you have ‘free fluids’. This means any drink you feel like including soup. Please do not drink very creamy drinks such as milkshakes or frappuccinos.

We will let you start to eat the morning after your surgery. Do not expect to eat a whole meal, but pick at simple foods you like when you are ill such as toast, yoghurt, ice cream. If you feel well during day 1 then continue to build up to whatever you would like to eat.

Chewing gum

With your parent or carers’ permission, we will ask you to chew sugar-free gum after the operation. Sometimes the bowel stops pushing food and wind through your tummy after a big operation. Chewing gum has been shown to help get the bowel working again. You will start by passing wind and may not poo for several days. This is nothing to worry about. Your appetite will come back quicker and your recovery much smoother if we can prevent the discomfort after the operation.

On the day you come into hospital please bring some chewing gum with you. After your operation chew gum for 15 minutes, three times a day, until your bowel function returns to normal. Please do not chew gum on the morning of your surgery.

Movement and rehabilitation

Unless told otherwise, you can move yourself around the bed from the time you wake-up after the operation. Sitting up as soon as you can and doing deep breathing exercises will prevent problems such as chest infections delaying your recovery.

Even after major spinal surgery, the sooner we get you out of bed and walking, the less likely you are to suffer complications from your surgery. The nurses and physiotherapists on the ward will therefore aim to get you out of bed from the first day after your operation.

Cannulas and catheters

A cannula (drip) is a small thin flexible tube placed into a blood vessel, normally in your hand or arm. It allows us to give you medicines like painkillers without you having to swallow them.

A catheter is a soft tube placed into your bladder on the day of surgery when you are asleep to allow you to wee. It also helps us monitor your progress and keep you well during the operation.

Enhanced recovery is about trying to help you feel ‘normal’ as soon as possible after the operation. We will start removing these tubes day 1 or 2 so that you can move around more freely.

Pain control

It is important that your pain is controlled so that you can breathe deeply, move, eat and drink, feel comfortable and sleep well.

Having some pain is to be expected but it should not stop your progress as you will be given medicine to enable exercises and keep you as comfortable as possible.

Some of that medicine will start the evening before your surgery in preparation for helping you manage your recovery. However we use it in a different way for just a short time while in hospital and can be stopped when you leave hospital.

Pain nurses will visit you daily to assess and adjust your medicines as needed and the staff on the ward will regularly check how you are managing with your pain.

We will start to decrease the pain relief you receive through the drip (cannula) in your hand from the first day as this has been shown to improve your recovery. We will make sure you have enough pain relief that you can swallow so that you can do your exercises.

Monitoring progress and expected stay

Your recovery will be monitored throughout your stay by all the specialists involved in your care. You will be seen by an orthopaedic doctor every day who will be able to answer any questions you may have on your recovery, especially if there is anything you are worried about.

Enhanced recovery is a relatively new concept in spinal surgery and so we will be asking you to fill in questionnaires about your experience. Please do help us to continually improve the care we provide by answering all the questions honestly. Please do talk to us about your hospital stay and we welcome any ideas on how your care can be improved.

You will be allowed to go home as soon as you feel you can manage at home. You should expect to be in hospital for 3 to 6 days after your operation. Although this may not sound like very long, enhanced recovery aims to keep your stay as short as possible.