It might seem a small matter, but the recent recommendation, reported in this paper last week, that patients should be permitted to eat and drink up to two hours before an operation must rank among the most significant and welcome advances in surgical practice of the past 100 years.
To clarify. The rationale for the customary edict of “nil by mouth for 12 hours before an operation” – to minimise the hazards of anaesthesia-induced vomiting and aspiration – seems eminently plausible. The situation has been even worse for those undergoing bowel surgery, as the “nil by mouth” edict is extended until normal functions are resumed – which can take up to a week.
Intuitively, it seems a bad idea that the trauma of an operation should be compounded by a state of semi-starvation, but it never occurred to anyone to challenge it. around 15 years ago, an American surgeon, Dr Michael Pearl, demonstrated that not only could patients undergoing bowel surgery tolerate modest amounts of food and drink almost immediately after the operation, but that it accelerated their recovery.
This prompted a re-examination of the 12-hour pre-op rule, with a similar outcome. The results have been dramatic, with a sharp fall in infection rates and wound complications. Patients are better nourished and go home sooner – with no rise in readmission rates. A most welcome advance indeed.
The plight of the gentleman with soreness of the legs “like sunburn” has elicited similar experiences. “I cannot be comfortable with anything touching the area or when leaning back on a chair,” writes one lady, whose sunburn sensation extends over her upper back. her symptoms suggest allodynia, an acute sensitivity of the skin to light touch that was mentioned in this column last week.
While the reader has found that massaging the affected area with Johnson’s Baby Lotion brings short-term relief, she says applying a layer of clingfilm or local anaesthetic spray over the “sunburnt” area will almost certainly increase the respite.
This week’s conundrum is courtesy of mrs H A from Lancashire, currently enduring an episode of excruciating pain beneath the shoulderblade that has occurred at five-yearly intervals over 20 years. It begins slowly, building to a crescendo with bursts every few seconds. “I can’t begin to convey how painful it is,” she writes.
During an attack she can neither sit or lie down, “sleep is out of the question, and it is difficult to do anything other than pace the floor”. this persists for around five days before disappearing – until the next time. Has anyone experienced anything similar, she wonders.
Finally, my thanks to David Thacker from Northampton for passing on his favourable experience with the unusual-sounding Kuznetsov’s Applicator, so named after its Russian inventor, Ivan Kuznetsov. this consists of a length of cloth into which are sewn hundreds of plastic discs from which protrude half a dozen upward-facing spikes.
Since a rugby injury several years ago, Mr Thacker had been troubled by neck problems that are particularly tiresome at night. When a Latvian friend recommended the applicator, he thought it “a daft piece of Eastern European quackery”. but when he discovered he could order it on the internet for around £10, he decided to give it a go.
The device uses a principle at work in a bed of nails, the circus contraption also favoured by devotees of the Vedic tradition of early Hinduism and Chinese acupuncture: the downward pressure of the body on the sharp spikes stimulates meridian pressure points, encouraging the production of endorphins, the body’s natural painkillers.
After a half-hour session it feels a bit sore initially, with a general sensation of warmth. but a fortnight later, Mr Thacker reports, “I have re-established a healthy sleeping pattern and now wake up pain-free.” Fascinating.
Doctor’s Diary: Eating before an operation