Preparing for Surgery

Preparing for Surgery

• Obtain Preoperative Clearance and have results faxed to the office at least 1 week prior to surgery. Failure to do so may result in rescheduling your procedure.
• Schedule your initial post-operative physical therapy session for the first day after your surgery, unless instructed otherwise by the surgical team. To schedule, call 915-910-1351.
• Set up initial postoperative appointment with our office.
• Medications: Stop taking medications as instructed per your PCP.
  • 2 weeks before surgery stop narcotics, and NSAIDs.
  • 7 days before surgery stop blood thinners unless instructed otherwise by the prescribing provider.
• Durable Medical Equipment Get fitted for braces, crutches and review cold therapy units before surgery, if indicated. Cold therapy is effective at reducing pain and swelling postoperatively – it is always a good idea to use cold therapy.
• Pick up Post-operative medications form your pharmacy.
• Midnight the night before surgery Do not eat or drink between now and your surgery.

Physical Therapy

• Prior to surgery, you can arrange to attend physical therapy beginning on the day after your surgery unless instructed otherwise by the clinical team. You will get the prescription at the time of surgery, but you can make the appointment before. Plan on attending outpatient physical therapy at least 2-3 days per week at the beginning of the recovery process. Please remember to bring both the prescription and the protocol you received on the day of surgery to your initial physical therapy visit.

Medications

• 14 days before surgery stop:
  • Any Narcotics (such as Vicodin, Norco, Darvocet, Percocet or Oxycontin).
  • Stop NSAIDs (Advil/ibuprofen, Aleve/naproxen, etc.) * If pain is severe, Advil is allowed on an as needed basis.
  • Discontinue Diet Supplements (i.e. Phentermine)
• 7 days before surgery stop:
  • Blood thinners need to be discontinued with written permission from your physician (example: Plavix, Coumadin, Warfarin, prescribed Aspirin)
• Medications that are OK to take prior to sugery:
  • Tylenol
  • Celebrex
  • Daily Vitamins

On the Day of Surgery

• Do NOT eat or drink anything after midnight before your surgical date.
• Do not drink alcohol or use recreational drugs for 24 hours prior to surgery and for 24 hours after.
• If you use an inhaler on a regular basis, please bring it with you to your procedure.
• If you have an illness such as a cold, sore throat, or stomach or bowel upset, please notify the office as soon as you can.
• Contact lenses, jewelry, piercings in and around the mouth, and dentures must be removed at the time of surgery. If you have acrilyc nails, please remove one nail from any finger, as our oxygen monitoring sensors do not penetrate acrylic nails.
• Take only prescribed medications instructed to be continued by your PCP, such as for hypertension (high blood pressure) or arrhythmias (irregular heartbeat). Be sure to inform your anesthesiologist of these conditions the day of surgery. If you take any of the following medications for your blood pressure, it is important that you discuss taking them with the anesthesia provider: Benazepril (Lotensin), Captopril
• (Capoten), Ena/april (Vasotec/Renitec), Fosinopril (Monopril), Lisinopril (Lisodur/Lopril/Novatec/Prinivil/Zestril), Perindopril (Coversy/Aceon), Quinapril (Accupril), Ramipril
• (Altace/Tritace/Ramace/Ramiwin), Zefenopril, Candesartan (Atacand), Eprosartan (Teveten), lrbesartan (Avapro), Losartan (Cozaar), O/mesartan (Benicar), Telmisartan (Micardis), Valsartan (Diovan)
• A responsible adult must accompany you to the procedure, remain in the office during the procedure, drive you home, and stay with you at home for 24 hours after the procedure. A taxi/Uber will not be allowed without a responsible adult accompanying you.
• If you are taking diabetic medications, you should check with your PCP to determine if you should take these medications on the morning of surgery.
• While taking narcotic pain medication, you will not be permitted to drive. You may need to arrange for transportation to your initial follow-up visit.

Anesthesia

• General anesthesia is used for many types of major surgery. During general anesthesia, the entire body, including the brain, is anesthetized. The patient has no awarness, feels nothing, and remembers nothing of the surgical experience afterward. General anesthesia is administered by injecting a liquid anesthetic into a vein, or by breathing a gas anesthetic flowing from an anesthesia machine to the patient through a mask or tube. A plastic endotracheal tube or a mask placed over the airway is frequently used to administer gas anesthetics. With the tube in place, the airway is protected from aspiration of stomach fluids into the lungs. It is normal to have a slight sore throat after your surgery and sometimes nausea.
• Injection of anesthetic into the neck region for shoulder surgery and on the thigh for knee surgery blocks pain impulses before they reach the brain. With this anesthetic, mental alertness is unaffected.
• Sedation, or even sleep may be offered to make you comfortable throughout the surgical experience. To receive the injection, you lie down while the anesthetic is injected into the neck or shoulder region. To make placement of the needle almost painless, your skin is first numbed with local anesthetic. This anesthetic may last for 6 to 8 hours and sometimes longer. It is important to start taking your postoperative pain medicine as soon as you begin to feel the onset of discomfort or when the numbness begins to wear off.

Tips for Effective Pain Management:

• Take your pain medication as prescribed but expect to use less after the first week or so.
• Take your pain medication before the pain becomes severe.
• Use cold therapy to physically reduce swelling and inflammation, the cause of pain, leaving you with less discomfort.
• Using cold therapy properly can help reduce the number of opioids you have to take.

Wound Management

• Maintain your operative dressing, loosen bandage if swelling of the foot and ankle occurs.
• It is normal for the incisions to bleed and swell following surgery. If blood soaks onto the dressing, do not become alarmed, reinforce with additional dressing.
• To avoid infection, keep surgical incisions clean and dry until your sutures are removed approximately 10-14 days after surgery. You may shower beginning post-operative day 3 so long as you place a plastic barrier over your surgical site. Follow the specific post-operative instructions provided to you on the day of your surgery regarding when to remove the surgical dressings.
• Please do not place any ointments lotions or creams directly over the incisions.
• Please do not scrub the incision. NO immersion in a bath, pool, ocean water or application of ointment/lotion to the surgical site until given approval by the surgical office.

Preventing Blood Clots:

• After surgery, clots called deep vein thromboses (DVT) may form in the leg veins. In rare cases, these leg clots travel to the lungs where they may cause additional symptoms. To prevent and reduce the incidence of clot formation, mechanical devices (foot or calf pumps) are used while you are in the Hospital to squeeze the leg muscles, thus maintaining blood flow in the veins. Also, a medication to minimize clot formation, such as warfarin (Coumadin), enoxaparin (Lovenox) or aspirin, will be prescribed.

Leg Swelling:

• Following surgery, most patients develop swelling in the operated leg or arm. Although the amount of swelling can vary from patient to patient, the swelling itself, in the leg, knee, ankle or foot, is normal and may be accompanied by “black and blue” bruising that will usually resolve gradually over several weeks.
• For the first month after your operation, prolonged sitting with your foot in a down position tends to worsen the swelling. You should not sit for more than 30 to 45 minutes at a time. Periods of walking should be alternated with periods of elevating your leg in bed. When elevating the leg, the ankle should be above the level of the heart. Lying down for an hour in the late morning or afternoon helps reduce swelling.
• Elevate operated leg or arm in bed on one to two pillows while lying flat. If you underwent knee surgery, DO NOT place the pillow (s) under the knee. You should have the pillow (s) under the foot and ankle only to allow for the full extension of the knee to be restored post-operatively. This is extremely important in the overall recovery of range of motion following knee surgery.
• Avoid sitting for longer than 30 to 45 minutes at a time.
• Perform ankle exercises.
• Apply ice to your surgical area for 20 minutes a few times a day.