Postop

At home

In the first 24 hours after surgery, you should avoid the following activities because you received anesthetic sedatives

  • Driving
  • Operating machinery/power tools
  • Drinking alcohol
  • Staying alone
  • Making important decisions or signing legal documents 

Call 911 or go to your nearest ER if you have the following

  • Chest pain
  • Difficulty breathing
  • Excessive bleeding
  • Any emergency situation 

Call surgical team for any of the following:

  • Excessive swelling that is not relieved with ice
  • Foul smelling odor from dressing or wound
  • Discharge from wound
  • Persistent nausea/vomiting
  • Fever greater than 101.5F.  It is typical to have a low-grade fever immediately postop.
  • Pain unrelieved by pain medication, elevation or ice. 

Call the pain service if you still have the pain catheter in place.

  • If you have catheter related issues, such as leakage
  • If you have significant pain – they may be able to give you directions over the phone to change the setting on the pain pump

Medications

  • narcotic medication -- you are prescribed one of these medications: take as needed for pain
    • oxycodone 5mg tablets – typical dose is 1-2 tablets every 4-6 hours.  You may need more than this amount, but please contact the surgical team first.
    • hydrocodone and acetaminophen (aka Tylenol) – this is Norco or Vicodin.  Typical dose is 1-2 tablets every 4-6 hours.  Do not take more than 4000mg of Tylenol per 24 hours.
    • Oxycontin 10mg tablets – aka sustained release oxycodone – you may be given this medication in addition to shorting-acting (immediate release) oxycodone; you can take both oxycodone and oxycontin in the first few days after surgery.  When your pain improves, oxycontin can be weaned off first, and you can regulate your pain with the immediate release oxycodone.  During the first evening after your day surgery, you should take 1 tab of oxycontin before you sleep even if the nerve block is still in effect to provide pain coverage when the block wears off during the early morning hours.
  • anti-nausea medication – Zofran (ondansetron) – take as directed if you have nausea.
  • Tylenol – if your narcotic medication does not contain Tylenol, you are encouraged to supplement with over the counter Tylenol.  Do not exceed 4000mg of total Tylenol per 24 hour period.
  • Stool softener – narcotic pain medication can cause constipation.  We suggest over the counter Colace and/or Senna/Sennakot when you are on pain medications.  High fiber diet is also recommended.
  • Non-steroidal anti-inflammatory medications (NSAIs) – e.g. ibuprofen, Motrin, aleve, naproxen – Until/unless you are cleared by the surgical team, do not take/resume these medications as they can impair bone/tendon healing.
  • Home medications – you can resume all your other home medications.  If you are taking immune-modulating medications, such as for rheumatoid arthritis or psoriasis, Dr. Shi may ask you to hold those for one week postop.  Please check with the surgical team.
  • You or your family can choose to pick up your prescribed medication at DCAM outpatient pharmacy prior to leaving the hospital.  If you decide to use your local pharmacy, please call ahead to ensure that they have the narcotics pain medication that you are prescribed.

Shoulder surgery

Many patients find it helpful to use a recliner to sleep in for a period of days after surgery because they are in a bulky shoulder sling and have trouble sleeping on either side.  With or without a recliner, you can use pillows to support either side of your torso while in bed.

 Follow up

  • A member of the surgical team will contact you the day after your day-surgery or day after you get home.  This will be a routine call to check on your progress and answer any questions you have.
  • You will typically return to clinic in 10-14 days for your first follow up appointment.  You are welcome to call the office to confirm the time and location of this appointment.

 Dressing/wound care

These are generic instructions; you may receive specific information for your surgery

  • Elbow surgery -- If you are placed in a plastic splint after surgery, please keep this dry.  You can sponge bath or choose to place a plastic bag over this limb during your wash.  If you are in a soft dressing, keep this dry for 3 days, and you can remove the dressing on 4th day after surgery; you can get shower then and get your incision wet.
  • Shoulder surgery – You can shower on the third day after surgery with the water-proof dressing in place.  After your shower, you can remove the dressing and leave it open to air.  Your incision may be covered with a layer of “super-glue” material or it may be cover in Steri-strips (adhesive paper).  You can wear normal clothes over your incision.  You do not need to cover your incision subsequently when showering; allow water to run over your incision and do not vigorously rub the incision.
  • Sling/shoulder immobilizer: If instructed to wear your sling until follow up, then use it at all times including at night.  You may remove sling when dressing or showering.  In the shower, you can let your arm rest at your side, on a railing, or the back of a plastic chair.  Avoid actively using this arm when showering.
    • Adjust your sling so that your elbow fits as far back into the pocket as possible, your elbow is bent at 90 degrees such that your forearm is parallel to the ground.
    • Your sling may or may not have a bump that goes around your waist.  Adjust it so that your hand is directly in front of your abdomen.
    • When lying flat or in recliner, it is helpful to have a pillow behind your elbow, so your arm is propped up, so your hand is directly over your abdomen.
    • A few times a day you can come out of sling to straighten your elbow.  Do not actively move your shoulder until you are cleared to do so.

Breg's Polar Care ice system

You may receive this ice system depending on the type of surgery.

Components

  • 5-quart portable cooler
  • Water pump in lid of cooler
  • Electric air pump
  • Manual hand pump
  • Ice pad/wrap 

Application/assembly

  1. Place ice pad over affected area with a towel separating the pad and the skin.  Initially this is done immediately postop in the operating room.  The picture illustrates placement of the pad; one long Velcro strap goes under the opposite arm-pit, and the shorter Velcro gose around the operated arm.
  2. Fill cooler half way with ice, and add water up to the line inside the cooler
  3. Place lid on cooler and lock by pulling up on the handle.
  4. Connect ice pad to tubing that’s connected to the lid.  Make sure that both of the silver tabs at the connection site “Click” when pushed in.  The pad will connect if the silver tabs are not pushed in but it will lead to leakage.
  5. Connect the air hose from the electric pump into the air hose connected to the cooler lid.
  6. Plug the electric pump into the electric wall outlet.  If electricity is not available you may use the manual hand pump 

Usage

  • Use the ice system continuously day and night for the first 3-5 days following surgery.  You may continue to use it at your discretion after that if you find it helpful.  Some patients continue to use it even 1-2 months after surgery because they find it helpful to control their pain and swelling. 

Questions?

  • Consult the directions and troubleshooting tips located on the back of the cooler.
  • If problems are not solved, contact Breg representative Josh Weil at(312) 421-4718 or (312) 217-6203