POSTOPERATIVE
INSTRUCTIONS FOR OUTPATIENT SURGERY
EXPLANATION:Orthopedic surgery is now commonly done in an “outpatient” setting allowing you to have surgery and return home both safely and comfortably the same day. Some surgical procedures require you stay overnight in the hospital. (23-hour observation surgery) rarely, a patient will have nausea or pain, which is severe enough following an outpatient procedure to require overnight hospitalization.
Activity:After you arrive at home, spend most of the first twenty- four hours in bed, on the couch, or in a reclining chair. After the first twenty-four hours at home, increase your activity level based on your symptoms, but remember that the longer you stay in bed, the longer it will take for you to feel better and get your strength back. Swelling / inflammation control and achieving range of motion goals are the primary focus for the first 2 weeks after surgery.
Pain Management: Pain medications, anti – inflammatory medications, cold therapy, physical therapy, local injections and, in some cases, regional anesthesia injections are used to manage your post- operative pain. The use each of these options will be directed by your surgeon.
Medications: You should have been given a prescription for pain medication before leaving the hospital. Have the prescription filled at a pharmacy on your way home and follow the instructions on the bottles. If you need a refill on your medications, please have your pharmacy contact us.
Narcotic Medication (usually Norco, Vicodin or Percocet): Begin taking the narcotic medication as soon as possible even if your pain is not severe, as the long acting numbing medication (Marcaine) given during the surgery will wear off within 8 hours after surgery. If you wait until your pain is severe, you will be very uncomfortable for several hours waiting for the narcotic to work. Always take the narcotic medications with food.
DO NOT: Mix with alcohol.
DO NOT: Drive while taking narcotics.
DO NOT: Take additional Tylenol while on Norco, Vicodin or Percocet (as they contain Tylenol)
After post-operative day two, it is OK to discontinue the use of narcotics as symptoms allow. These medications are pain –masking ONLY and have no other beneficial effects. Therefore, if you don’t have pain, don’t continue to take these medications.
Non-Steroidal Anti-inflammatory Drugs - NSAIDs (Celebrex, Naproxen, and Ibuprofen): Taking NSAIDs to control inflammation may be a part of controlling your pain. Always take this medicine with food. Do NOT take the NSAID if you have an ulcer, rashes, difficulty breathing, swelling of the face or neck, or if you have a history of problems taking a NSAIDs.
Cold Therapy: The use of cold therapy will relieve pain and control swelling. It can be achieved in a number different ways. A cold pump unit is a continuous icing machine. Freeze packs, ice bags (crushed ice is best), or frozen peas also work well. When using a re-freezable product, ice for 20 minutes at a time with an hour in between. Whatever the means be very diligent with your icing. Use cold therapy throughout the day and night for the first 4 days and then decrease frequency to 2 times/day.
Regional Anesthesia Injections: You may have been given a regional nerve block either before or after surgery. This may make your entire extremity numb for 24-36 hours.
Diet: Eat a bland diet for the first day after surgery.
Dressing Change: Your dressing should be changed by a Physician Assistant within 7 days from surgery. Unless you are given other instructions, DO NOT removes the dressing until instructed to do so. If you are concerned about drainage or the appearance of your wound or dressing, please call the office. Your surgeon will instruct you as to when it is OK to get your wounds wet. Until then bathing is preferred to showering, but do not submerge the wound or dressing. If showering is necessary, protect the surgical area from moisture by wrapping it in saran-wrap or a plastic garbage bag with rubber bands. Do not remove or apply ointment to the tape strips (steri-strips) that are over the portals for 14 days, however if they fall off before 14 days, please re- apply a Band-Aid. Please phone immediately if the following symptoms occur: excessive drainage, redness surrounding the incisions/portals or “streaking” from it, increased pain or temperature.
Sutures: Some sutures do not need to be removed because they dissolve. Non-absorbable sutures will be removed at about 2 week’s post- op.
Swimming, hot tubs and bathing: Do not submerge your wounds before 3 weeks post operatively and the Doctors given the clearance to do so.
Physical Therapy: Physical therapy may start the day after surgery or up to 6 weeks after surgery, depending on the type of procedure. Your doctor, or his assistant, will instruct you when and where to start. If you change the location of your therapy, alert your previous therapist with your new therapist’s name and number, so the rehab plan can be transferred.
First Post-operative Office Visit: Your first visit to the office will range from the next day up to 14 days after surgery. Call as soon as possible to make your appointment by calling (510) 687-9510.
If you have any problemsafter office hours, please call (510) 687-9510. A low grade fever of under 101.0F is common for the first two days after surgery. Deep breathing can minimize this. If fever persists or you have any increasing pain, drainage or redness, please call the office. Any chest pain, shortness of breath or other worrisome medical complaint should be managed with a call to 911 or visit to your nearest emergency room.
Special instructions for elbow or shoulder surgery:
SLING OR BRACE: If you have been given a sling or brace, wear it 24 hours a day, except for range of motion exercises for the elbow, hand and shoulder as instructed. Remove to shower, but re-apply for sleep or lounging around.
Special instructions for knee, leg or ankle surgery:
ELEVATE your leg whenever possible. Elevation means that the operative region is closer to the ceiling than your heart.
WEIGHT BEARING: Your weight bearing will be determined by the doctor after surgery.
BRACE: If you have been given a brace, wear it 24 hours a day, except for range of motion exercises for the first 6 weeks. DO NOT remove to sleep or lounge around. Do not wear over pants (okay to wear over leg hose or tights). OK to remove when you are IN the shower, but re-apply BEFORE you exit.
TED HOSE: These socks are to be worn for the first 2 weeks after surgery. They serve the dual purpose of decreasing the chance of blood clot formation and to aid in controlling swelling in the lower extremities. You may remove the socks daily wash and dry, but please wear them as much as possible to gain full benefit. Be sure to move /rotate both ankles frequently during the day. This will promote circulation and drainage of swelling.
CPM: CPM (or Continuous Passive motion) machines may have been provided to help improve your pain and range of motion (ROM). They typically should be used for 6-8 hours/day. It is most efficient to sleep with them turned on, logging beneficial hours during sleep. Your surgeon or physical therapist will give you instructions on how to adjust the machine to achieve maximum benefit. The speed should be adjusted to 25% of the maximum speed. Your initial settings should be increased by 100 in each direction (flexion and extension) each day until the maximum prescribed range of motion is achieved. For example, if your initial settings are 300 of extension and 700of flexion and your maximum ROM is 900, and then adjusts the CPM to 200of extension and 800of flexion on post-surgery day 1. Then change the settings to 100 of extension and 900of flexion on day 2. Then change to 00of extension and 900of flexion on day 3, etc.