Preoperative Patient Instructions
It is natural to be quite anxious about your upcoming surgery. We have prepared these Preoperative Patient Instructions to help familiarize you with what to expect and to hopefully make your day of surgery go as smoothly as possible. If you have any questions not addressed here, please call the office at (337) 478-9653, Monday through Thursday, 8:00am until 5:00pm, or Friday, 8:00am until noon.
Medications:
Please bring all of your home medications with you to the hospital. This will help us to identify what you are taking and how often. The morning of surgery please take only medications that we have specifically indicated, with a sip of water only. Do not take any diabetes medications, pain medications, sedatives, or blood thinners. If you are on any blood thinners such as aspirin, Plavix (clopidogrel), Ticlid (ticlopidine), Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), Savaysa (edoxaban), or other, please let your surgeon know in advance of your surgery date. You may be asked to temporarily stop taking these medications.
Please tell us about your medication allergies and your response to these medicines. Please also tell us if you are sensitive to iodine or have had previous problems with anesthesia.
MRI scans, CT scans, and X-rays:
The radiology studies that you had prior to surgery are critical to performing your operation. Please bring these studies with you the morning of surgery. If these studies are not available your surgery may be postponed.
Bring Your Brace:
If you are having neck surgery and were given a brace then please bring it with you to the operating room. It will be put on in the operating room while you are still asleep. If you are having back surgery and were given a brace then please have your family bring it to your hospital room.
Delays:
Every attempt will be made to begin your surgery on time as scheduled. Frequently there are delays, however. These can arise from other emergency surgeries, other operations taking longer than expected, or preparation time of equipment. There are literally hundreds of tools necessary for your surgery. In rare situations your surgery may be cancelled and rescheduled if your doctor decides this would be safest for you. Your understanding and cooperation is appreciated in advance.
Your Family and Friends:
Prior to leaving for the operating room you will be able to visit with a limited number of family and friends. Please let the operating room nurse know who will be waiting on you during the operation and where. Family and friends typically wait in the Surgery Waiting Room. Your nurse will contact your family/friends about every 60-90 minutes for an update from the operating room. Your doctor will contact your family/friends after surgery.
Who will be in the Operating Room:
The operating room team consists of a number of highly trained individuals to assist with various aspects of your care. In addition to your surgeon, there may be a surgeon’s assistant, one or two surgical technicians (to handle and prepare instruments), one or more nurses, the anesthesiologist and anesthetist. A manufacturer’s representative may be present to assist when complex equipment is being used. Residents or Interns will not be participating in your surgery.
Before the Operation:
Prior to being taken to the operating room you will stay in the “holding area.” Here you will meet the Anesthesiologist or Anesthetist and the O.R. nurse. Your identity will be confirmed, as will the type of operation to be performed. All of your paperwork will be double-checked and laboratory results reviewed. An I.V. will be started and occasionally additional laboratory studies will be obtained. You will see your surgeon prior to going to the operating room.
In the Operating Room:
In the operating room you will be connected to several monitors to record your blood pressure, heart rate, breathing, and other vital signs. You will then be given medications to allow you to drift off to sleep under general anesthesia. After surgery you will be taken to the recovery room and allowed to wake up.
In the Recovery Room:
You will still be groggy upon arrival to the recovery room. Here, nurses will closely monitor you as you awaken and will give pain medicines as needed. You might have a catheter in your bladder and this may give the sensation of needing to urinate. After about an hour you will be transferred to a hospital room where you will be reunited with your family and friends.
Postoperative Patient Instructions
Dressings and Incision Care:
In general, wound dressings are left on for a minimum of two days after surgery. The bandage should be kept clean and dry. If it becomes soiled or wet then it may be replaced with a new sterile gauze bandage and secured in place with tape. After two days the bandage may be removed (except for carpal tunnel surgery in which the bandage must be kept in place and dry for two weeks).
Underneath the bandage expect to see staples, sutures or steri-strips depending on your surgery. These should be left alone and let stand to air dry. Do not coat the incisions with ointment or other products unless specifically told to do so. Staples and sutures will need to be removed in the office 7-14 days after surgery.
Watch Your Incision:
Wound problems are rare but can occur after any type of surgery. Signs of problems include increasing incisional tenderness, redness, swelling or discharge. If any of these occur or you develop a temperature greater than 100.5 degrees F, please call the office right away.
Showering:
If your bandage is covered with a thin sheet of plastic (resembling cellophane) then it is waterproof and you may shower after surgery. However, if your bandage does not have a clear plastic coating and is held on with tape, then you must keep your dressing dry until it may be removed (see above). After the dressing is removed you may shower. Blot the wound dry with a clean towel; do not rub. You may briefly remove a neck brace (keep your head as still as possible) or back brace to shower but it should be replaced as soon as possible. Do not submerse the wound, take a prolonged shower, or otherwise soak your wound for a period of six weeks.
Follow-Up:
You will need to be seen in the office about 7-14 days after surgery. When you are discharged from the hospital you may be given a follow-up appointment. If not, you will need to call the office at (337) 478-9653 the next business day to arrange your follow-up appointment.
Medications:
After surgery you may resume your previous home medications with some exceptions. Please consult with your doctor before resuming blood thinners.
If you are given an antibiotic prescription, please take the full course of medication at the prescribed dosing interval.
If you have had a spinal fusion operation then DO NOT take anti-inflammatory medications such as Motrin (ibuprofen), aspirin, Naprosyn (naproxen), Aleve, Toradol (ketorolac), Relafen, Daypro, Arthrotec, or other non-steroidal antiinflammatories (NSAIDs). These drugs can slow bone healing and complicate fusion operations. You may take Tylenol (acetaminophen) or the pain medicine prescribed for you.
Narcotic pain medicines may be given for pain control during the immediate postoperative period. These may be taken as directed for post-surgical pain. Because of the addictive nature of narcotics, patients should taper their use as tolerated. Narcotics will not be refilled indefinitely, nor will they be refilled after normal business hours. If you receive pain medications from a medical pain management specialist then you must obtain all narcotic medications through that physician. Do not seek pain medication prescriptions from other physicians while we are prescribing your pain medications.
Please anticipate your medication needs several days in advance if possible. Requests for medication refills will only be handled during regular business hours. When getting your prescription filled, please consult with your pharmacist regarding any possible interactions with other drugs you may be taking. Also, review the package insert supplied with your medication(s) to familiarize yourself with possible side effects. Please call the office at (337) 478-9653 if you suspect any medication related problems.
When taking narcotics, sedatives or muscle relaxers, do no consume alcohol, drive a motor vehicle, or operate dangerous tools or heavy machinery.
Diet:
You may return to your previous home diet as tolerated. Your throat may be sore from surgery and thick liquids or soups may be more comfortable for you to consume at first. If you are diabetic then you will want to watch your glucose levels closely the first week or so after surgery. Your primary care doctor may recommend a specific diet for your medical condition(s).
The Bathroom:
People are often constipated after surgery and this can result from a combination of anesthesia, pain medication, bed rest, and other factors. Over-the-counter preparations such as Colace (ducosate sodium) lOOmg by mouth twice daily can help with constipation not resulting from narcotics. If you have constipation as a result of narcotics, please contact our office for a prescription specific to this. Please call the office if you have not had a bowel movement within several days after surgery.
Please call the office if you have any persistent urinary burning, increased frequency or urgency. New onset incontinence of bowel or bladder is extremely rare but requires immediate attention.
Smoking and Other Tobacco Products:
Nicotine from cigarettes or any other tobacco product is bad for your recovery. Aside from promoting cancer, heart disease, stroke, and other bad things, nicotine has been shown to increase complication rates in spine fusion operations by 3-5 times. Stop smoking!!!
Activities and Expectations:
Adherence to limitations of activity after surgery is important to promote wound healing. These restrictions are dependent upon the type and location of surgery (e.g. back, neck, brain, or peripheral nerve). Similarly, symptoms you may expect after surgery are dependent upon the type of surgery.
Back Surgery:
Keep your sitting to a minimum, preferably less than twenty minutes at a time. You may sit in the bathroom or while eating. If you must sit longer, take frequent breaks to walk and stretch your legs. Keep automobile riding to a minimum as this counts as sitting time. Reclining in the car seat on the way home from the hospital can help. No driving for two weeks after surgery. Sitting in a recliner chair is acceptable. Avoid laying on your stomach. Lie either on your back or on your side with pillows between your knees. Absolutely, NO bending, NO stooping, NOR twisting for six weeks after surgery. DO NOT lift anything heavier than ten (10) pounds. If you have to ask if something can be picked up, the answer is probably NO.
Walking is encouraged. Prior to each walk do twenty (20) leg swinging exercises with each leg. Support your weight with one leg and swing the other leg back-and-forth at the hip. At first, walk very short distances 4-10 times per day, then slowly increase the distance and decrease the number of times per day. Build up to about a mile twice daily at four weeks.
You may expect soreness after surgery. This typically peaks around three days after surgery before beginning to subside. You may still have occasional pain and burning sensations. The irritated nerves can continue to give you symptoms for a period of weeks. This is nothing to worry about, but is a reflection of the injury to the nerves from pre-existing compression within the spine.
After six weeks recovery you may request referral to a physical therapist specially trained in rehabilitation and body mechanics. The therapist can instruct you regarding exercises that will enable you to rehabilitate yourself to the maximum degree.
If You Have a Back Brace:
It is not necessary to wear a back brace while in bed or in a recliner chair. Stand or sit to put the brace on. The brace must be worn any time you are going to be up for a period of time. You may go to the bathroom without the brace.
Neck Surgery:
DO NOT lift anything heavier than a newspaper or coffee cup. If you have to ask if something can be picked up, the answer is probably NO. DO NOT push or pull with your arms. Chores such as ironing, vacuuming, sweeping, and mopping should be avoided.
No driving for a minimum of two weeks after surgery. Before returning to driving you must have adequate neck mobility. Please abstain from driving if your neck is stiff, sore, or you must continue to wear a cervical collar or halo.
Walking is encouraged. At first, walk very short distances 4-10 times per day, then slowly increase the distance and decrease the number of times per day. Build up to about a mile twice daily at four weeks.
After surgery you may feel a “lump in the throat”, a sore throat, or have mild difficulty swallowing. These are normal side effects of operating through the front of the neck and will resolve with time. Cepacol lozenges may help with some of this discomfort.
Brain Surgery and Head Injuries:
Intermittent headaches are common after brain surgery or head injury. If you experience increasingly severe or increasingly frequent headaches then please call the office. Other symptoms to watch for include increasing nausea or vomiting, confusion, visual blurring or double vision, weakness or numbness on one side of the body, difficulty with speech or comprehension of speech, neck stiffness and sleepiness. Increasing “puffiness” or drainage of fluid from the incision site, ear(s) or nose should be reported. For any of the above signs or symptoms, please call the office at (337) 478-9653.
After brain surgery or a head injury you will probably feel physically tired. Advance your activity slowly and do not engage in any heavy physical exertion. Avoid extremes of heat; stay indoors at first. It is best to have someone stay with you initially if you live alone. Do not consume alcohol or other recreational drugs as they may interact with your prescription medications.
If you are on anti-seizure medication(s) then the drug levels may need to be checked at a subsequent office visit.
Do not drive until cleared by your doctor. If you had a seizure then you may not operate a motor vehicle for a period of six months per Louisiana State Law.
Peripheral Nerve Surgery:
Your post-operative instructions will depend specifically on the nerve which was operated upon. In general, keep the bandage clean and dry for a period of two weeks. If the bandage becomes wet or soiled, please call the office at (337) 478-9653 for a dressing change. You may take a shower with the bandage on but place a plastic bag over the limb and secure it in place with a rubber band. Do not put any salves or ointments on the wound unless specifically told to do so.
If your bandage is too tight, please call the office to arrange for us to adjust it. Symptoms can include numbness, the limb “falling asleep” or pale fingers/toes.
If you had carpal tunnel surgery, please get a small rubber ball such as a racquetball from a sporting goods store or department store. Squeeze the ball then stretch your fingers straight for ten (10) repetitions every several hours while awake to help build your hand strength and maintain mobility.