Preoperative Care - Lumbar Spine

Before Surgery

Obtain Laboratory Tests-Pre admission testing (PAT)

When you were scheduled for surgery your physician's office also scheduled you for pre-admission testing (PAT). Please see the first page of this notebook for date and time. Follow the instructions given to you at your physician's office, and report to Same Day Surgery Center at the Johnson City Medical Center at the appropriate time. When you report for pre-admission testing, you will be asked the following information in order to pre-register you for surgery:

• Patient's full legal name and address, including county
• Home phone number
• Marital status
• Social Security Number
• Name of insurance holder, his/her address, phone number, work address, and work phone number
• Name of insurance company, mailing address, policy and group numbers, and insurance card
• Patient's employer, address, phone number and occupation
• Name, address and phone number of nearest relative
• Name, address and phone number of someone to notify in case of emergency (this can be the same as the nearest relative)

*Be sure to bring your insurance card, driver's license or photo I.D. with you to this appointment.

Arrival Time At Hospital

When you have your pre-admission testing done, you will be instructed on what time to arrive at the hospital the morning of your surgery. You will be asked to come to the hospital two hours before the scheduled surgery to give the nursing staff sufficient time to start IVs, prep and answer questions. It is important that you arrive on time to the hospital because sometimes the surgical time is moved up at the last minute and your surgery could start earlier. If you are late, it may create a significant problem with starting your surgery on time. In some cases tardiness could result in moving your surgery to a much later time. Parking is available in the visitor lots for free.

The Night Before Surgery

Do Not Eat or Drink

Do not eat or drink anything after midnight, EVEN WATER, unless otherwise instructed to do so. No chewing gum.

Special Instructions

Follow specific instructions given to you at your physician's office and at your preadmission testing regarding medications.

What To Bring To The Hospital

Personal hygiene items (toothbrush, powder, deodorant, battery-operated razor, etc.); watch or wind-up clock; hand-held mirror to use at bedside; shorts and tops; well-fitted slippers, flat shoes or tennis shoes. For safety reasons, DO NOT bring electrical items. You may bring battery-operated items.

You must bring the following to the hospital:

• your Patient Guidebook
• a copy of your Advance Directives
• your insurance card, driver's license or photo I.D., and any co-payment required by your insurance company

Other things to remember:

• please leave jewelry, valuables and large amounts of money at home
• makeup must be removed before your procedure
• remove nail polish

Pre-Op Exercises

It is not completely up to your surgeon to heal your back .You must partner with your surgeon for optimal results. It is important to be as fit as possible before undergoing spine surgery. This will make your recovery much faster. You should begin the exercises shown in your Guidebook and continue until your surgery. Repeat each exercise 20 times. You should be able to do them in 15-20 minutes and it is recommended that you do all of them twice a day. It is not harmful for you to do more. Consider this a minimum amount of exercise prior to your surgery.

Also, remember that you need to strengthen your entire body, not just your back. It is very important that you strengthen your arms by doing chair push-ups, because you will be relying on your arms to help you get in and out of bed, in and out of a chair, walk, and to do your exercises post-operatively. Stop doing any exercise that is too painful.

Home Preparation for return from Hospital

Have your house ready for your arrival back home. Clean. Do the laundry and put it away. Put clean linens on the bed. Prepare meals and freeze them in single serving containers. Cut the grass, tend to the garden and other yard work. Pick up throw rugs and tack down loose carpeting. Remove electrical cords and other obstructions from walkways. Install nightlights in bathrooms, bedrooms and hallways. Arrange to have someone collect your mail and take care of pets or loved-ones if necessary.

What types of anesthesia are available?

Decisions regarding your anesthesia are tailored to your personal needs. Certain illnesses can potentially make one type of anesthetic better than another. For instance, a patient with emphysema would probably do better with a spinal. Meanwhile, a patient with a bleeding disorder or on anticoagulants can not have a spinal due to the risk of bleeding in the spinal canal.

The types available for you are:

• General Anesthesia renders the patient unconscious for the duration of surgery. The patient is typically sedated prior to surgery and put to sleep once in the operating room and awakened in the recovery room.
• Regional Anesthesia techniques include spinal blocks, epidural blocks, and arm and leg blocks. Patients undergoing spinal block are also usually sedated prior to surgery and the spinal is placed in the operating room. This involves sitting the patient upright on the operating table, numbing the skin low in the middle of the back, and with a small diameter needle injecting a dose of local anesthetic which begins to work almost immediately. Patients are then sedated for the rest of the operation and allowed to stay in the recovery room until most of the spinal has worn off.

Will I have any side effects?

Your anesthesiologist will discuss the risks and benefits associated with the different anesthetic options, as well as any complications or side effects that can occur with each type of anesthetic. Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Although less of a problem today because of improved anesthetic agents and techniques, these side effects continue to occur for some patients. Medications to treat nausea and vomiting will be given if needed. The amount of discomfort you experience will depend on several factors, especially the type of surgery. Your doctors and nurses can relieve pain with medications. Your discomfort should be tolerable, but do not expect to be totally pain-free. The staff will teach you the pain scale (1-10) to assess your pain level.

What will happen before my surgery?

You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review all information needed to evaluate your general health. This will include your medical history, laboratory test results, allergies and current medications. With this information, together you will determine the type of anesthesia best suited for you. He or she will also answer any further questions you may have.