Modern advances in surgical and anesthesia techniques have allowed many surgical patients to safely go home immediately after an operative procedure. This has resulted not only in significant cost savings, but in most cases provides a much more comfortable recovery environment. This handout provides post-operative guidelines for the most common surgeries. If you have any questions or concerns that are not answered here, please call my office. In an emergency, go to the nearest hospital emergency room.

Diet

Following surgery, most people experience a period of nausea, which can last anywhere from several hours to several days (48 hours). In most cases, nausea is the result of the anesthetic medication and is made worse by taking pain medication, especially Percocet or Roxicet. Therefore, it is recommended that you begin taking food slowly. Start with clear liquids (de-fizzed cola, broth, tea) and, if tolerated, progress to dry crackers and bananas. Do not take pain medication on an empty stomach. If you have vomiting that continues for more than eight hours, and you are unable to take any liquids, please return to the hospital emergency room. Additionally, if nausea lasts for more than 48 hours, if you notice blood or coffee ground material in your vomit, or if your stomach becomes distended please seek medical attention immediately.

Voiding

Difficulty making urine can have two causes. One cause is that your body is dry and unable to make urine. In this case you will feel thirsty and your mouth may be dry. Often, this is a result of post-operative nausea. Try to drink as much liquid as you can in the first 24 hours after surgery. If you can not tolerate the liquids and are still not making urine, then return to the hospital for evaluation. The second cause of voiding problems is when you feel full of urine, but are not able to pass the urine (this is typical in middle-aged males with enlargement of their prostate, after spinals or epidurals; it is rare in females). In this instance, the bladder has become distended and the muscles can not relax to allow urination. If this happens, you will need to return to the hospital for a catheterization.

Pain

It is typical to experience pain after a surgical procedure and the pain should be controlled by the narcotic pain medication provided. Typically, this pain medication is either Vicodin or Percocet, both of which are an artificial form of codeine. If you have an allergy to codeine please make sure that we are aware of that fact and have discussed it with you. Do not take the medication if you have previously had an episode of breathing difficulty (anaphylaxis) after taking codeine or one of its derivatives. Pain following surgery is usually worse for the first three to five days and then will subside gradually. It should be relieved by medication, rest, elevation and the use of ice. If the pain becomes so severe that it is not alleviated by narcotic medication, loosen or remove the dressing on the area to decrease the pressure. If the pain is still severe, or if the pain has been diminishing and then suddenly increases without explanation, please contact me or return immediately to the hospital emergency room.

Swelling

Swelling is to be expected and usually increases for three days after surgery. Dressings are applied to lessen the swelling, as well as provide protection to the wound site. If there is significant swelling to the extremity beyond the dressing, loosen the dressing and elevate the leg or arm. Perform ankle pumps or finger motion to help prevent stiffness. Remember, swelling is easier to prevent than to cure. For this reason, it is important to elevate the extremity and stay off of it for the first 72 hours following surgery.

Dressing Care

Keep the dressing as clean and dry as possible. If there is drainage through the dressing, reinforce it with a clean towel. Typically, there may be some bleeding, but this is not a concern. If the bleeding completely soaks the dressing as well as a reinforcing towel, please contact me or proceed to the emergency room for evaluation. Unless instructed otherwise, you may remove the dressing on day three and if the wounds are dry, leave them open to air. If there is still drainage, a dry bandage should be applied.

Instructions: Please Read Carefully

1. Have a family member or friend drive you home. A responsible adult should remain in close contact with you for the first 24 hours after surgery.

2. Protect the involved area for 24 hours. Use crutches or sling as necessary for pain control and protection. Unless otherwise instructed, you may put as much weight on the leg as tolerated. You may remove the sling for skin care but avoid extreme motion of the shoulder.

3. Use ice for pain control and swelling. Apply an ice bag or a 2 pound bag of frozen peas to the outside of the bandage as needed. If you have a Polar Care or other similar device, leave it on until instructed by the physical therapist. After the dressing is removed, avoid placing ice directly on the unprotected skin or wound. After 72 hours, use ice no more than 20 minutes out of an hour, 2 to 3 times per day until swelling is resolved.

4. Keep the dressing clean and dry. You may remove the dressing in 2-3 days and leave the wounds open to air if dry. If the dressing becomes wet, remove and reapply a dry dressing. If there is bleeding or drainage through the dressing, reinforce with a clean towel.

5. If you have been given a brace, you should use it all the time. You may remove it while sitting, showering or while in the CPM machine. The therapist will instruct you in further use.

6. Unless instructed otherwise, begin gentle motion immediately and progress as tolerated by pain and muscle control. Early motion helps to prevent stiffness and decrease swelling. If you have a CPM machine, start using it as soon as possible after surgery. Use the CPM three hours out of every eight hours and increase the motion as tolerated. If you are comfortable using it more frequently, feel free to do so. If you can not tolerate the CPM, do not use it and contact your therapist. After 72 hours, if the wounds are dry and have no drainage, you may shower. Do not bathe, swim or use a hot tub until the sutures are removed and the wounds are healed.

7. Call my office (333-2580) for a return appointment. Typically, this is five to seven days after surgery. At that time I will remove the sutures.

8. If you have had an ACL surgery, you should begin physical therapy the next day or during the first available appointment. If you do not have an appointment or a prescription, please call my office. For other surgeries, we will discuss the need for physical therapy at your first return appointment and proceed from there.

9. I will provide a work excuse from the time of your surgery to your first return appointment. If you feel capable, you may return to work prior to the visit. I encourage you to return to work as soon as possible after surgery. Work is an excellent form of therapy, both physical as well as mental.

10. Unless instructed otherwise, you may return to driving when you feel capable of safely operating a motor vehicle. I will instruct you if I see any harm to your surgery from the act of driving. It is your responsibility to determine if you are capable of controlling a vehicle within the applicable laws of your state. If you have questions in this regard, contact the Bureau of Motor Vehicles or local police, particularly if you are in a cast or on crutches.