After brain tumour surgery
This page tells you about the first few hours and days after brain tumour surgery. There are sections about
After brain tumour surgery
You will probably be in intensive care or a high dependency unit for at least one night after your operation. When you first come round, a nurse will make neurological observations and take your blood pressure every 15 minutes. You will have several different tubes in place. You will probably have a drip, a drain coming from your wound, a tube down your nose into your stomach to stop you being sick, and a tube (catheter) into your bladder.
You may have a headache when you wake up. Your specialist may not want you to have strong painkillers because this could mask important symptoms. It is important to tell someone if your headache is getting worse. It could be a sign of swelling inside your skull, and you may need more steroids to control it. It is unusual to get a lot of pain after a brain operation.
The next few days
It is important not to strain to do anything, as this could raise the pressure inside your head. You will be encouraged to move your arms and legs regularly. As soon as the surgeon says you can, your nurses will help you get up, starting gradually by sitting in a chair. You usually have a dressing on your wound for about 5 days.
You may have difficulty swallowing. At first, your nurse will give you sips of water, then gradually, starting with clear soup, you can build up to having normal meals again.
It is difficult to give you an exact idea of what will happen as there are different types of brain tumour operations. They vary widely depending on the exact position of the tumour and its size. Some people are unconscious for days after the operation, but most are awake almost immediately afterwards. You will probably wake up in the recovery unit of the operating theatre, in intensive care (ICU) or in a high dependency recovery unit (HDU). This is nothing to worry about. These are places where you can have one to one nursing care. And your surgeon and anaesthetist can keep a close eye on your progress.
As soon as your doctors and nurses are sure that you are recovering well, you will be moved back to the ward. You will probably be in intensive care for at least one night. But exactly how long you are there will depend on the type of operation you have had. And on how you respond to the surgery. If you have just had a biopsy, you may not be in intensive care at all, but just on the high dependency area of the neurosurgical ward.
What you will notice first is your intensive care nurse taking neurological observations. These are the same tests you had before your operation. You will have a blood pressure cuff on your arm and a little clip on your finger to measure your pulse (called a pulse oximeter). You will also have an oxygen mask on for a while. Your blood pressure and neurological observations will be measured every 15 minutes when you first come round.
When you are fully awake, you will notice that you have several different tubes in place. This can be a bit frightening. But it helps to know what they are all for. You may have
- Drips (IVs - intravenous infusions) to give you medicines, blood transfusions, and fluids until you are eating and drinking again
- A tube into an artery in your wrist or ankle for taking blood samples and accurately measuring your blood pressure
- One or more drains coming out of your wound (connected to bags or bottles) to drain blood and tissue fluid from the operation site
- A tube into your bladder (catheter) so that your urine output can be measured
- A tube down your nose into your stomach (nasogastric tube) to stop you from being sick
Among the tubes coming out of your head bandages, there may be a drain called an external ventricular drain (EVD). This drains excess fluid from the brain to stop the fluid building up (hydrocephalus). You may also have an intracranial pressure (ICP) monitor. This measures the pressure inside your head. It will be taken out after a day or so, once things have settled down.
Your nurse will measure your urine output because this helps to show whether you have too much fluid in your body or too little (are becoming dehydrated). Keeping your fluid balance right helps to stop swelling around the operation site in the brain.
You may have a headache when you wake up. You will have painkillers to help control this. But your surgeon may not want you to have strong painkillers because they could cover up important symptoms. It is important to tell your doctor or nurse if you think your headache is getting worse. This may be a sign of swelling inside your skull and you may need more steroids to help control it.
It is unusual to get a lot of pain after a brain operation. If you have had surgery on your spine, you may have more pain. If so, you may have painkillers through a drip. Do say if you feel your painkillers are not helping as much as they should. Your nurse can adjust the dose if necessary.
All your nursing for the next few days will be designed to stop you straining to do anything. Any sort of strain can raise the pressure in your head. You may have to lie flat for a few days. Or you may have the head of your bed raised to help stop swelling in the brain. Whether you are flat or propped up depends on the type of surgery you've had. Your doctors and nurses will be keen to get you up and about as soon as possible.
Depending on the operation you have had, your nurses will regularly move you from side to side or onto your back to stop you getting pressure sores. While you are still in bed, you will be encouraged to move your arms and legs frequently to help your circulation and keep them mobile. Or your nurse will move your arms and legs for you, 2 or 3 times a day, to stop them stiffening up.
When you are awake, your nurse will remind you to take deep breaths every hour, but not to cough because this can increase the pressure in your head.
Within 48 to 72 hours, you may have a brain scan - either a CT scan or MRI scan. This will show if there is any tumour left and how much swelling there is in the area of the operation. It may be uncomfortable having a scan so soon. But this is the best time for your surgeon to get a good picture of the operation site.
You will have a tube down your nose at first (a nasogastric tube). This will attach to a drainage bag. It is there to stop you from being sick. Being sick is a strain and raises the pressure inside your head.
As soon as you are fully awake, your nurse will give you a few sips of water. The nurse will watch carefully to make sure you don't have any problems swallowing. This can sometimes happen after brain surgery. You may have your swallowing checked by a speech therapist before you are allowed anything to eat or drink. Once you can manage sips of water without feeling or being sick, you can have the nasogastric tube taken out. Gradually, starting with clear soup, you can build up to having normal meals again. At first, your nurse or a relative may feed you so as not to tire you out.
You will have a dressing over your wound site when you wake up. Your drains will come out about 24 hours after your operation. If you have a dressing, it will usually be left alone for about 5 days. Stitches or surgical clips can usually come out between 5 to 14 days after surgery. Some surgeons use stitches that slowly dissolve by themselves (especially in children) and so you don't have those removed.
If you had to have your head shaved when you went to theatre, it may be a shock when you first see yourself. Your hair will grow back quite quickly though. Your head may be itchy at first, but try not to scratch too close to your wound.
If your operation was near your temple (between the side of your eye and your hairline), you may find that your jaw is stiff and painful a few days or weeks after surgery. You may find it difficult to open your jaw. This is because the surgeon had to move or cut the muscles of the jaw during your operation. The stiffness gets better by itself in a short time. Making chewing movements or chewing gum helps.
Getting up and moving around may seem impossible at first. Moving about helps you to get better and also reduces the risk of blood clots in the legs (DVT), but you will need to start very gradually.
Your nurses will encourage you to get out of bed and sit in a chair as soon as your surgeon says you are able. Gradually, the time you are allowed to stay up will get longer. When you first start walking, you will have to have someone with you. At first, it may be the physiotherapists who help you with this. As long as you have no leg weakness, it will gradually become easier to get around and you will really feel that you are beginning to make progress.
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