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Moira M.McCarthy, MD
Hospital for Special Surgery

Peri-Operative Instructions

BEFORE SURGERY:

  • SURGERY – PLACE All surgeries take place at the Hospital for Special Surgery. The address for the Hospital for Special Surgery is 535 East 70th Street, NY, NY 10021.
  • SURGERY – INSTRUCTIONS You will receive a call from the hospital the day prior to the operation. The nurse will tell you what time to arrive at the hospital, where to go upon arrival (usually the 9th Floor Ambulatory Operating Rooms), what medications to take the morning of the operation, and when to stop eating and drinking. In most cases, you will be told not to eat or drink anything after midnight.
  • MEDICAL TESTING Medical clearance including laboratory blood tests, an electrocardiogram (ECG), a chest radiograph, and a visit with a medical doctor at the hospital will be ordered for anyone over the age of 50 years and for anyone with medical issues that need to be addressed prior to surgery. Healthy patients under age 50 years may not need any medical clearance.
  • ANESTHESIA Most surgeries are done with regional anesthesia. This includes a nerve block and some medication to help you relax. You have the option of requesting general anesthesia. You will meet your anesthesiologist the day of the operation and will discuss all the possible options. You have the option of scheduling a meeting with an anesthesiologist prior to your operation. This is not required. If you would like to schedule this meeting, please contact my office manager to help arrange this.
  • MEDICAL EQUIPMENT I will be ordering a brace or sling and an ice machine for you to take home with you after your surgery. The company may call you in the days prior to the operation to discuss this with you. Often, your insurance may not cover the fee for the ice machine. There is a rental fee or a purchase fee depending on the type of ice machine you choose. The specific fees will be discussed with you. I highly recommend the ice machine as it will help with the swelling and pain post-operatively.
  • PRESCRIPTIONS I will mail you a packet of information prior to your operation. This packet will include specific instructions regarding your operation and medication prescriptions for after your surgery. It is recommended to fill the prescriptions in the week prior to your surgery so that you have the medications at home when you arrive after the surgery.
  • Please make an appointment to see me in the office approximately 10-14 days after your operation. This will be the time for a wound check and suture removal.

DAY OF SURGERY:

  • I will meet you in the peri-operative holding area prior to your operation. We will review the procedure to be performed and I will answer any outstanding questions. I will mark your operative site. You and I will sign a consent form for the operation.
  • I will speak to your family members/friends in the waiting area after the operation. They will be able to see you when you are settled in the recovery room.
  • In the recovery room, a nurse will attend you to. I will speak with you in the recovery room, but you may not remember because of the anesthesia. I will call you the day after surgery to see how you are doing and answer any questions.
  • Your brace or sling will be applied in the operating room. This brace or sling is essential and you must wear it unless I tell you otherwise.
  • PHYSICAL THERAPY You will meet a physical therapist in the recovery room. The therapist will show you the exercises you are allowed to do and may give you a sheet of paper to take home with you reminding you of the appropriate exercises.
  • Keep your operated extremity elevated as much as possible. If you have knee surgery, place a pillow under your ankle/lower leg to keep the leg extended. Do NOT put a pillow behind your knee. If you have shoulder surgery, you may want to sleep in a reclined position with your head/shoulder elevated to decrease the pain and swelling over the first few days.
  • If any changes to your post-operative pain medications are necessary, you will be provided with new prescriptions before you leave the hospital. See the instructions at the end for common medication instructions.

DAY 1 AND UNTIL FIRST POST-OP VISIT:

  • I will call you the day after surgery to see how you are doing and to answer any questions.
  • ICE MACHINE The ice machine will aid in decreasing pain and swelling. Use the machine for 20-30 minutes at least 4 to 6 times per day for the first few days. After that, use it at least 2 to 3 times per day. You should use it more frequently if you are having continued pain and swelling.
  • WOUND CARE If you have a large bandage such as an ace wrap on your extremity you should remove that after 48 hours. There will be waterproof bandages over all your incisions. If these are clean and dry, you may leave them until your first post-operative appointment with me. If the dressings are soiled or become wet, remove them, pat the area dry, and apply clean bandaids daily. Leave the steri-strips (small white tapes) on all incisions. Do NOT apply any sort of cream or ointment (including bacitracin, Neosporin, Mederma, or anything else) to the incisions at this time. Keep the incisions clean and dry until 2 days after the stitches are removed in my office. Place waterproof dressings over all incisions to keep them dry when showering.
  • SHOWERING You may shower after 48 hours as long as the incisions stay clean and dry and you are stable enough to get in and out of the shower. For shoulder surgeries, you may remove the sling to shower. For knee surgeries, wrap your knee with plastic wrap and secure it with tape around your thigh. Then, place the brace on and cover it with a cast bag or a garbage bag with a hole cut in the bottom for your foot. Secure it with tape around the thigh and ankle. If the sutures do get wet, pat them dry and apply clean bandaids. Cast bags can be purchased at the local drug store.
  • Use any necessary assistive devices (sling, brace, crutches) as instructed. Do not make decisions to remove a brace or sling on your own as this may negatively impact the outcome of your surgery. These are necessary devices and must be used as instructed. If you have questions, please call the office to ask.
  • Do the instructed post-operative exercises. If you are given a prescription for physical therapy, you should set up your appointment and begin therapy. If you are not given a prescription for physical therapy, you should do only the exercises taught to you by the therapist or myself.
  • Avoid alcoholic beverages and illicit drugs when taking pain medications, especially those that include narcotics. This may result in serious or possibly fatal side effects.
  • WORK/SCHOOL You may return to work/school in the next few days after surgery when you feel up to it. Surgery often makes you fatigued for days-weeks and each person is different. You may need to start out slow and gradually build up your time spent away from home. You will need extra time at school, an elevator pass if necessary, room to elevate your leg/arm, and additional help. I can provide you with a note for work or school if you need one.
  • Call the office with any questions. Make sure you have an appointment to see me between 10-14 days after surgery.

MISCELLANEOUS INFORMATION:

  • WOUND CARE There may be some bleeding or fluid leakage from the incision sites after surgery. This is normal after this type of surgery. This may continue for 24-48 hours. You may change and/or reinforce the bandages as needed. Do NOT remove the steri-strips (white tapes) covering the incisions even if they are wet or bloody.
  • SWELLING There will be MORE swelling on days 1-3 than there is on the day of surgery. This is normal. The swelling will decrease with the anti-inflammatory medication, the ice machine, and keeping it elevated. The swelling will make it more difficult to move your fingers, wrist, and elbow after shoulder surgery and more difficult to move your knee after knee surgery. As the swelling goes down, the movement will become easier.
  • BRUISING There may also be associated bruising down the arm to the hand or down the leg to the foot. This is also normal and is due to gravity. Monitor this to ensure that it is not increasing after days 2-3. If you are concerned, call the office.
  • There may be some numbness on the skin around the incision sites. This is normal. It may last for up to 6-12 months.
  • FEVER It is normal to develop a low-grade fever after surgery (up to 100.4). This can last up to 3 days after surgery. If your fever is higher or you have any concerns, please call the office.
  • CONSTIPATION Pain medication may make you constipated. Try the following solutions in the order listed:
    • Take colace (stool softener).
    • Decrease the amount of narcotic pain medication you are taking.
    • Stay well hydrated. Drink decaffeinated fluids.
    • Drink prune juice.
    • Take Senakot (over the counter laxative).
    • Take Miralax (stronger, over the counter laxative).
    • If none of the above have helped significantly, call the office. Call the office if you experience significant abdominal pain and/or uncontrolled nausea or vomiting.

COMMON MEDICATIONS:

  • NARCOTIC PAIN MEDICATION Usually this will be Percocet or Norco. These are pain medications. They contain narcotics, which are powerful pain medications. These medications will be necessary for you to take in the days after surgery. You will find that you can decrease the number of pills taken after the first few days. They (Percocet and Norco) also contain Tylenol. There is a maximum daily limit of 3 g of Tylenol per day, so take only the prescribed amount of these pills. Narcotic pain medications cause constipation so stay well hydrated and take a stool softener (see below).

    INSTRUCTIONS FOR PERCOCET:
    Percocet 5/325 (5 mg oxycodone and 325 mg Tylenol per tablet).

    Take 1-2 tablets every 4-6 hours as needed. Maximum number of Percocet pills in a 24-hour period is 10.

    INSTRUCTIONS FOR NORCO:
    Norco 5/325 (5 mg oxycodone and 325 mg Tylenol per tablet).

    Take 1-2 tablets every 4-6 hours as needed. Maximum number of Norco pills in a 24-hour period is 10.

  • ANTI-INFLAMMATORY PAIN MEDICATION Usually this will be Naproxen. This medication is essential to help with the pain, swelling, and inflammation from the surgery. You should take this medication twice a day as prescribed. This medication can have an impact on your stomach, so take it with food and discontinue taking it if you develop stomach pain or any concerning GI issues.

    INSTRUCTIONS FOR NAPROXEN:
    Naproxen 500 mg tablet.

    Take 1 tablet with food twice a day. Maximum number of naproxen pills in a day is 2.

  • BABY ASPIRIN This is an anti-coagulant. Taking this will help prevent blood clots (DVT). Of course, if you have any significant symptoms concerning for a blood clot (increase in swelling, pain, fever) please call the office. Aspirin, like naproxen, can also cause stomach problems. If you develop stomach issues, please discontinue taking the medication and call the office.

    INSTRUCTIONS FOR ASPIRIN:
    Aspirin 81 mg tablet.

    Take 1 tablet with food once a day.

  • ANTI-NAUSEA MEDICATION. This medication is only to be taken if you are nauseous post-operatively. If you do not need to take it, don’t take it. If you need to take it, take it only as directed.

    INSTRUCTIONS FOR ZOFRAN:
    Zofran 4 mg oral dissolving tablet.

    Take 1 oral dissolving tablet every 6 hours as needed for nausea/vomiting.

  • STOOL SOFTENER This medication is to be taken to prevent constipation. Take this only as long as you are taking the narcotic pain medication or if you need it. And stay well hydrated. If you are having constipation even after taking this medication, please refer to the miscellaneous section above for further instructions.

    INSTRUCTIONS FOR COLACE:
    Colace 100 mg tablet.

    Take 1 tablet three times a day.