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A guide for patients

Your day of surgery, from booking to going home

Almost all shoulder, elbow, hand and wrist operations are done as a day case, so most patients go home the same day. A few larger operations, such as some shoulder replacements, may need one or more nights in hospital, and Mr Jepson will tell you in advance if that applies to you.

This guide explains each step for operations at Circle Three Shires Hospital in Northampton and Woodland Hospital in Kettering, in plain English, so you know what to expect and what to prepare.

Call 01604 633730 Contact the practice

Your journey at a glance

  1. Booking your surgery
  2. Consent
  3. Pre-assessment
  4. The days before
  5. Admission on the day
  6. Theatre and recovery
  7. Physiotherapy on the ward
  8. Going home

Step by step, from booking to discharge

Every hospital has its own routine, but the steps below are what most patients can expect. The hospital will send you its own written instructions, and those always come first.

If anything is unclear at any stage, contact the practice and the team will help.

  1. Booking your surgery

    • Mr Jepson explains the operation, its benefits, risks and the alternatives, including not operating. You decide together, with no pressure and time to think.
    • If you are insured, you get authorisation for the procedure from your insurer using the procedure details the practice gives you. If you are paying for yourself, the hospital sends you a written quote. The insurance and self-pay steps on the homepage explain both routes.
    • The hospital then confirms your operation date.
    Reception at Circle Three Shires Hospital
    Reception at Circle Three Shires Hospital, where you check in for your clinic appointment

  2. Pre-assessment

    Usually a nurse-led appointment, in person or by phone, a week or more before your operation. It makes sure you are ready and safe for your anaesthetic.

    • A health questionnaire about your general health and any previous anaesthetics.
    • Blood tests, a heart tracing (ECG) or MRSA swabs, only if you need them.
    • A full review of your medicines. Tell the nurse about blood thinners, diabetes medicines, and weight-loss or diabetes injections such as GLP-1 medicines, as some need to be paused before surgery.
    • You are given your arrival time and your fasting instructions.

  3. The days before

    • If you are having a general anaesthetic or sedation, arrange for a responsible adult to take you home and stay with you for 24 hours.
    • Bring a loose, button-front top that will fit over a bulky dressing and a sling.
    • Remove watches, bracelets and nail varnish from the arm being operated on.
    • Shower on the morning of your operation.
    • If you smoke, stopping, even for a short time, helps your wound and your recovery.
    • If you become unwell, for example with a cough, fever or a skin infection on the arm, tell the practice before you come in.

    Take your rings off before you come in

    Remove all rings from the fingers of the hand on the side of your operation, ideally the night before, and leave them safely at home.

    Why this matters: the hand and fingers often swell after surgery, even after a shoulder operation while the arm rests in a sling. A ring that fits comfortably now can quickly become tight and restrict the blood supply to the finger, and it may then have to be cut off. If a ring will not come off, tell the practice before the day.

  4. Admission on the day

    • Arrive at the time you were given. This is earlier than your operation time, to allow for checks.
    • You are shown to your own patient room on the ward, and a nurse checks your details, any allergies and when you last ate and drank.
    • Mr Jepson sees you, answers any questions, confirms your consent with you in person and marks the arm with an arrow.
    • The anaesthetist meets you to agree the anaesthetic with you.
    • There may be some waiting, as operations run in order through the list. A book or something to listen to helps.
    A patient room at Circle Three Shires Hospital
    A patient room at Circle Three Shires Hospital, where you settle in before and after your operation

    TED (anti-embolism) stockings

    The nursing team fits you with TED stockings. These are snug elastic stockings that keep blood moving in the leg veins and lower the risk of a blood clot while you are less active. The ward team will explain how to wear them and how long to keep them on.

  5. Theatre and recovery

    • You are monitored throughout the operation by the anaesthetist and theatre team.
    • Afterwards you spend some time in Recovery, then return to your own patient room on the ward.
    • You are offered something to eat and drink.
    • Nurses check your comfort, the circulation in your hand and your dressing.
    Mr Alistair Jepson operating in theatre
    Mr Jepson in theatre, working with the same team who look after you throughout your operation
    Nerve blocks used to numb the arm for upper limb surgery
    A regional nerve block numbs the arm, so many operations can be done without a general anaesthetic

  6. Physiotherapy on the ward

    A physiotherapist visits you in your room on the day of your operation.

    • They show you your early exercises, so you know what to do once you are home.
    • They explain how to protect the arm while it heals, including how to wear your sling if you have one.

    The aftercare and sling guide covers recovery at home in more detail.

  7. Discharge

    You can usually go home once you have eaten and had a drink, any discharge medicines are ready for you, you have passed water, and your escort is with you. Going home below explains more. You go home with:

    • Painkillers and how to take them
    • A sling, where you need one
    • Wound and dressing instructions
    • A follow-up appointment for a wound check, usually around 10 to 14 days
    • Physiotherapy or hand therapy, arranged where you need it
    • A number to call if you have any concerns

Eating and drinking before your operation

This is typical guidance for adults having a general anaesthetic or sedation. Fasting matters because an empty stomach reduces the risk of stomach contents entering the lungs while you are asleep.

The hospital's own written instructions always take priority.

If the times below differ from the ones the hospital gives you, follow the hospital's.

Food

No food for 6 hours before. This includes milk, sweets and chewing gum.

Clear fluids

Water, black tea or coffee without milk, or clear squash until 2 hours before, or the time the hospital gives you.

Medicines

Take your usual medicines with a sip of water, unless you have been told otherwise at pre-assessment.

Two simple examples

Morning list

  • Last food around 2am, or a late evening snack before bed.
  • Clear fluids until about 2 hours before your admission time, as instructed.

Afternoon list

  • A light breakfast, finished by about 7am.
  • Clear fluids until the time the hospital gives you.

If your operation is under local anaesthetic

Operations done with local anaesthetic alone often need no fasting. If you are having a nerve block, you may still be asked to fast, in case sedation or a general anaesthetic is needed on the day. If you are unsure, call the practice on 01604 633730.

Anaesthetic options for the shoulder, elbow, hand and wrist

Upper limb surgery can often be done with a nerve block that numbs the arm, either on its own or alongside a general anaesthetic. Mr Jepson may suggest what usually suits your operation, but the anaesthetist, not the surgeon, makes the final recommendation with you on the day. Mr Jepson works with a regular group of experienced anaesthetists, described on his About page.

General anaesthetic

You are asleep throughout the operation. A general anaesthetic is often combined with a nerve block, so the arm stays comfortable for several hours afterwards.

Interscalene block

For shoulder and upper arm surgery

An injection at the side of the neck, placed under ultrasound guidance. It is often combined with a general anaesthetic. Common temporary effects include a hoarse voice, a droopy eyelid on that side, and a feeling of breathlessness, because the nerve to the diaphragm is usually affected for a few hours. Tell the anaesthetist if you have significant lung problems.

Brachial plexus block

For elbow, forearm, wrist and hand surgery

A supraclavicular, infraclavicular or axillary block, given around the collarbone or in the armpit. The whole arm goes numb, so many operations can be done with you awake or lightly sedated, without a general anaesthetic.

Local or wide-awake anaesthetic

For smaller hand operations

Local anaesthetic is injected around the area being operated on, and you stay awake and comfortable. It suits operations such as carpal tunnel release and trigger finger release.

WALANT: wide awake hand surgery

Wide Awake Local Anaesthetic No Tourniquet

WALANT is a gentle, well-established way of doing many hand operations with you awake and comfortable, and without a general anaesthetic, sedation or a tight cuff on the arm.

What it is

Local anaesthetic mixed with a small amount of adrenaline is injected around the area being operated on. The adrenaline narrows the small blood vessels, so there is little bleeding and no tight tourniquet cuff is needed on the arm. You stay awake and comfortable, with no general anaesthetic or sedation.

Why it is often used for hand surgery

It suits many common hand operations, for example carpal tunnel release, trigger finger release, Dupuytren's surgery and ganglion removal.

Because you are awake, Mr Jepson can ask you to move your fingers during the operation, to check that a tendon glides freely or a finger straightens before the wound is closed.

What it means on the day

  • The injection stings briefly, then there is a short wait while the anaesthetic and adrenaline take effect.
  • During the operation you feel touch and pressure, but not sharp pain.
  • There is no tourniquet discomfort and no grogginess afterwards, and you can usually go home soon after.
  • You may not need to fast, but always follow the fasting instructions the hospital gives you.

See eating and drinking before your operation for more on fasting.

Who it suits

WALANT is not right for everyone or for every operation. Mr Jepson will talk it through with you at your consultation, and a nerve block or a general anaesthetic remains an option if you would prefer not to be awake.

Read more about nerve blocks

The Royal College of Anaesthetists publishes a patient leaflet that explains nerve blocks for upper limb surgery in more detail:

Nerve blocks for surgery on the shoulder, arm or hand (PDF, Royal College of Anaesthetists) (opens in a new tab)

Serious or lasting nerve problems after a nerve block are rare. Your anaesthetist will talk you through the benefits and risks of each option before anything is done.

Looking after a numb arm

After a nerve block, the arm may be numb and weak for several hours, and sometimes until the next day. This is expected, and feeling returns gradually.

  • Keep the arm in the sling while it is numb.
  • Protect it from heat, cold and knocks, because you cannot feel it. Keep it away from radiators, hot drinks and ice packs.
  • Support the arm on a pillow when you sit or lie down.

Start your painkillers before the block wears off

Take the painkillers you were prescribed before the numbness fades, for example in the evening and again before bed, rather than waiting for pain to start. It is much easier to stay comfortable than to catch up once the pain has arrived.

Going home the same day

Day case surgery means you recover in your own home, with clear instructions, a follow-up wound check and therapy arranged where you need it.

Before you leave hospital

You can usually go home once:

  • You have eaten and had a drink
  • Any discharge medicines are ready for you
  • You have passed water

Discharge is usually led by the nurses. Mr Jepson will try to see you before you leave if he can, but he would not want you waiting unnecessarily if you are ready to go home while he is still operating.

Once you are home

  • Keep active. Take gentle walks and move your legs and ankles regularly, even while resting.
  • Keep well hydrated. Drink plenty of fluids through the day.
  • Keep on top of your pain. Take your pain relief regularly, as advised, rather than waiting until it hurts.

You must not drive yourself home, and must not drive for at least 24 hours after a general anaesthetic, sedation or a nerve block, so please arrange for someone to collect you. After that, when you can drive again depends on your operation, your sling or splint and your recovery, as explained in our guide to when you can drive again after surgery.

Blood clots: signs to know about

Blood clots after upper limb surgery are uncommon, and keeping active and well hydrated helps lower the risk. It is still important to know the signs.

Deep vein thrombosis (DVT)

A DVT is a blood clot in a vein in the leg. Signs include pain, swelling, warmth or redness in the calf or leg.

Contact the hospital or your GP promptly.

Pulmonary embolism (PE)

A PE is when a clot travels to the lungs. Signs include sudden breathlessness, chest pain or coughing up blood.

This is an emergency: call 999.

The first 24 hours

After a general anaesthetic or sedation:

  • Have an adult with you overnight
  • Do not drive or drink alcohol
  • Do not cook with hot pans or operate machinery
  • Do not sign important documents

Driving

Only drive again once you are out of the sling and can control the car safely, including an emergency stop. Check with your car insurer before you drive, as some policies have their own conditions after surgery.

Mr Jepson will give you guidance for your operation at your follow-up appointment.

When to call

Contact the hospital or the practice if you notice:

  • Increasing pain that your painkillers do not control
  • Redness around the wound, or a fever
  • Leakage from the wound or dressing
  • A cold or pale hand
Call 01604 633730

Who to call if you have a problem after going home

Call the ward at the hospital where you had your operation. The nursing team there can advise you and contact Mr Jepson if needed.

Circle Three Shires Hospital, Northampton

01604 620311

Woodland Hospital, Kettering – ward reception

01536 536833

For questions about your follow-up or therapy, call the practice on 01604 633730. In an emergency, call 999.

Common questions about the day

For recovery after a specific operation, see the guide for your condition on the conditions page.

Do I have to complete my consent online?

The secure Concentric link is the usual route, because it lets you read about your operation at home, in your own time, and share it with family. If using it is difficult for any reason, for example you do not have a suitable device or the link will not open, call the practice on 01604 633730 and the team will help. Consent with Concentric above explains each step.

Can I eat if my operation is under local anaesthetic?

Often, yes. Operations done with local anaesthetic alone usually need no fasting. If you are having a nerve block, you may still be asked to fast in case sedation or a general anaesthetic is needed. Always follow the instructions the hospital gives you.

Will I be awake during the operation?

It depends on the operation and what you and the anaesthetist agree. Many elbow, wrist and hand operations can be done awake or with light sedation under a nerve block, and smaller hand operations under local anaesthetic. Shoulder operations are usually done with a general anaesthetic as well as a block.

How long will my arm be numb?

After a nerve block, usually for several hours, and sometimes until the next day. Keep the arm in its sling, protect it from heat, cold and knocks, and start your painkillers before the feeling returns.

Will Mr Jepson see me before I go home?

He will try to if he can. Discharge is usually led by the nurses, and Mr Jepson would not want you waiting unnecessarily if you are ready to go home while he is still operating. You return to your own room on the ward after Recovery, and can usually leave once you have eaten and had a drink, your discharge medicines are ready and you have passed water.

Can I go home on public transport?

No. After a general anaesthetic or sedation you need an adult to take you home by car or taxi, and to stay with you for 24 hours. Please arrange this before the day.

What if I feel unwell before my surgery?

Tell the practice as soon as you can, for example if you have a cough, cold, fever, or a cut or skin infection on the arm. It is sometimes safer to move the operation to a later date, and the team will help you decide.

Who do I call after my operation?

If you have a problem after going home, call the hospital where you had your operation: Circle Three Shires Hospital on 01604 620311, or Woodland Hospital ward reception on 01536 536833. For questions about your follow-up or therapy, you can also call the practice on 01604 633730. In an emergency, call 999.

Talk to the practice about your shoulder, elbow, hand or wrist

Call to arrange a consultation, book online for Circle Three Shires Hospital in Northampton, or send a short email and the practice team will come back to you.

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