Preparing for Surgery

One week before Surgery

If required, make sure you are cleared for surgery by your primary doctor and/or cardiologist.

Stop all anti-inflammatory/blood thinners including Coumadin, Xarelto, Plavix, Aspirin, Advil, Motrin/Ibuprofen, Aleve, Glucosamine, Chondroitin, Ginger, Ginseng, and all herbal medicines. Please contact your primary doctor before discontinuing Coumadin or Plavix or if your doctor told you to take aspirin.

Current Medications: You should continue taking your usual prescribed medications prior to surgery. Any exceptions to that such as a routine dose of aspirin, anti-inflammatory medications such as Advil, Motrin, Naprosyn, and Feldene, and Vitamin E should be stopped 10 days prior to surgery unless you specifically discussed continuing them with your surgeon. Discontinue all herbal supplements and vitamins at least two weeks prior to surgery if scheduling permits. Verify with your surgeon instructions regarding blood thinners, aspirin, NSAIDs, and similar products.

If you are on Coumadin therapy: check with your prescribing doctor regarding when you should discontinue and restart using the Coumadin. Blood testing may be required by this physician before and after the date of surgery.

If you are a Diabetic: Discuss with the nursing staff at the hospital or outpatient surgery facility the anesthesiologist’s recommendation regarding using your insulin or taking your tablets the morning of surgery.
You may take Tylenol (acetaminophen) for pain up until the night before surgery.
Find loose clothing that you can easily wear on the day of surgery under or over your surgical site.

If you get a cold/flu before surgery and have any of the following: fever, productive cough, unexplained rash, or are not feeling well please call our office or the surgery center to discuss whether you should postpone the surgery.

Day before Surgery

DO NOT eat or drink anything after midnight the night before your surgery is scheduled unless you have been specifically instructed otherwise by the nursing staff in the facility where you are scheduled. This includes gum, candy, ice, etc. They will discuss with you which medications you may take with a sip of water, if any, the morning of your surgery. You must understand that it is very dangerous to be sedated or put under general anesthesia with food or liquid in your stomach.

Remember to have an escort, 18 years or older, accompany you on the day of surgery for the drive home with appropriate transportation; this excludes a taxi.

Arrange for someone to be with you for the first 24 hours after your surgery.

You are encouraged leave jewelry and other valuables at home as all jewelry and watches be must be removed prior to surgery.

Check your cell phone and home phone in case your surgery time was changed.

Find loose clothing that can easily be worn on the day of surgery.

Shower the night before or morning of surgery with antibacterial soap to minimize the risk of infection.

Please bring the sling, immobilizer, crutches, or other medical equipment that was given to you regarding your injury, with you the day of surgery to the surgery center

The exact time of the surgery is determined by the surgery facility. Our office will call you with your check-in time after 3:00pm, the business day before your surgery is scheduled.

Please plan to arrive at the surgery facility at your designated time so that you have enough time to speak with your anesthesia provider and surgeon prior to your procedure and to ask any questions you may have.

Day of Surgery

You will be instructed to arrive at the surgical facility an hour or more prior to your scheduled procedure. After registration at the facility you will be escorted to the pre operative holding area where the staff will help you prepare for surgery.

Dress in loose, comfortable clothes that will be easy to change out of and into after surgery. Make sure that any potential bulky bandages or cast will fit through the openings.

Do not wear contact lenses, but bring reading glasses if you need them to complete any paperwork before surgery. Remove any hairpins, clips, or combs.

Do not wear any jewelry or bring anything valuable with you to the facility.
Please plan to arrive at the surgery facility at your designated time so that you have enough time to speak with your anesthesia provider and surgeon prior to your procedure and to ask any questions you may have.

Pre-Operative Area

Shortly after your arrival, you will be brought back into the pre-op area. Here the nurse will interview you and review your medical condition. Be sure to report to the nurse any recent illness or unusual symptoms you may be experiencing. After you are settled in pre-op and your IV has been started, if you would like, your companion may keep you company until you leave for the operating room.

In the pre-op area, you and the anesthesiologist will discuss the types of anesthesia, determine the best method for you, and have you sign the Anesthesia Consent. Again, it is important to share any information about your history with anesthesia so that any potential risks may be identified.

Then, just before you head back to the operating room, your surgeon will visit with you to answer questions, review the procedure with you, and mark the site of your procedure.

Your surgeon will also visit with you in the pre operative area to review your medical history, confirm the procedure plan and site and to provide an opportunity answer any further questions. The surgical consent will be reviewed again with you and the surgeon will mark the surgical site as part of the routine safety measures.

Operating Room

The anesthesiologist and your operating room (OR) nurse will accompany you through the automatic doors into our operating room suite. You will notice that all of the staff in this room wear masks, gowns, head covers and gloves. The equipment and instruments have been carefully prepared for your surgical procedure. The lights will be bright and the room will be chilly but our warmed blankets will help you relax.

After Surgery

Post-Operative Area

You will be closely monitored by the nursing staff in the Post Anesthesia Care Unit (PACU) as you begin to recover from your anesthesia. Your pain will be managed by the nursing staff per instructions from your surgeon and anesthesiologist.

The length of your stay in PACU will depend upon the type of anesthesia you received and the course of your recovery. Prior to your discharge from the center, the nursing staff will ensure that you are comfortable, able to take fluids, and can sit up on the bedside.

You will have a bandage on your surgery site and may also have a splint, brace or sling. When you are awake and able to eat and drink, you will be discharged with instructions for home. The post-anesthesia recovery period depends on the type and length of surgery. When you are ready to leave, the nurse will review instructions for postoperative care with you and your caregiver. You will be given a copy of these instructions as well as any prescriptions which may have been written for you by your surgeon.

You will be provided with instructions including how to take any necessary medications.

How long you wear a splint or sling depends on the type of surgery and your doctor will explain what activities and when/if therapy will be necessary.

When you go home eat small bland meals that night and advance to your regular diet when you are feeling well and have an appetite.

Check to ensure your first post-op appointment is scheduled according to the instructions.

Pain Management

Your anesthesiologist will review your medical history, discuss the anesthesia plan, and answer your questions. Surgery of the hand is often able to be performed comfortably and safely with IV sedation and local anesthesia. Regional nerve blocks can also be utilized for more extensive procedures and provide post operative pain relief often without the need for general anesthesia.

Cold Therapy/Ice

Cold therapy units may be used to help decrease pain and swelling and the need for pain medication. Used generally for shoulder, hip and knee reconstruction procedures, they are designed to maintain a constant cool temperature over the joint or extremity where you are having pain and swelling. It is a small cooler that is filled with ice and water. A pad is applied over your joint with velcro straps. The device should feel comfortable to you and maintain a cool temperature continuously by recirculating the ice water flowing to the pad. You will need to refill the ice every 3-6 hours. The device may be used during the

Pain Medication

Opiates (aka narcotics) are controlled substances. These prescriptions must be on paper and must be hand delivered to the pharmacy.

Types of opiates (in order of strength)

• Oxycodone with acetaminophen (aka Percocet)
• Hydrocodone with acetaminophen (aka Norco, Vicodin)
• Tramadol (aka Ultram)
• Codeine (aka Tylenol with codeine)

Acetaminophen aka Tylenol is not an anti-inflammatory drug but it is a pain reliever. It is added to most opiates as an additional pain reliever. Do not take more than 3 grams of Tylenol in a 24-hour period. Doses over 3 grams/day can be toxic to the liver.

Types of NSAIDs (non-steroidal anti-inflammatory drugs)

• Available over the counter: Motrin/Advil (aka ibuprofen, adult dose 600-800mg every 6 hours as needed for pain), and Aleve (aka naprosyn or naproxen, adult dose 250-500mg twice a day as needed for pain, Aspirin 81mg-325mg.)
• Prescription only: Celebrex (aka celecoxib), Mobic (aka meloxicam), Diclofenac (aka Voltaren – topical gel or oral tablets)

It is OK to take the opiate and NSAID at the same time. Pain medication is prescribed as needed. If you don’t want to take it you don’t have to. It is meant to control your pain to help make your recovery be more comfortable. You will likely need pain medication at least for the first 2-3 days. You will not be completely pain free during the healing,recovery and rehabilitation time.

We will prescribe an opiate for moderate to severe pain and recommend taking an NSAID (anti-inflammatory pain medication) for mild to moderate pain. You should start the NSAID the evening of the surgery and continue as directed until your post-op appointment or when pain has decreased.

Travel

Plan to stay in the area until your first post-op visit. If you have any problems or complications after surgery it is difficult to treat if you are more than a couple hours away. And we recommend you not travel by air until at least 4 days after surgery, due to risk of blood clots. If your circumstances necessitate you to travel by air earlier than day 4 post-op, please discuss this with your doctor prior to surgery. If you must travel in the first 4 weeks after surgery by airplane we recommend you take an 325mg aspirin daily to help prevent blood clot.

Driving

You should not drive if you are taking pain medication. If you are instructed to wear a sling you may not turn the wheel or shift with this arm. You must decide if you can safely drive and control your vehicle. Please check with your insurance agent about driving with a sling. We recommend that you not drive until the sling is off and you can drive safely. Specific restrictions for each surgical procedure differ, please contact our office with any questions you may have