Patient Resources

In general, you will be asked to fast for your surgery. This is for your own protection, as stomach contents are at risk for being aspirated into your lungs during general anesthesia. In most cases, you can eat and drink normally up until midnight the night before your surgery, and then fast afterwards. We ask that you refrain from drinking alcohol the night before your procedure. If you take a beta blocker medication, you will be asked to take that with a sip of water on the morning of your operation. If your case is later in the day, you may be allowed to have clear liquids up until 4 hours prior to your scheduled procedure time. Clear liquids includes black coffee (no creams or proteins), water, tea, soft drinks, sports drinks, apple juice…etc. No proteins means no coffee creamers or milk, broths, and the like. If your case is scheduled to be performed under local anesthesia, you may not be required to fast. Check with your surgeon during your preoperative visit or call the office to confirm what is recommended for you.

With very few exceptions, most of you will have had some type of local anesthesia during your procedure – even if you had a general anesthetic. As a result, when you awaken, your pain should be manageable. The recovery room nurses are there to monitor your pain level and give you medication as you require it. Some of you will have had a dedicated regional block and will be densely numb afterwards. Blocks last variable amounts of time, but most wear off within 12-24 hours. Anticipate this! This means you may want to consider taking a dose of your pain medication at bedtime, even if you’re not hurting. During the period you are numb, try not to “overdo it” as this can make the pain worse as the numbing agent wears off. Once the numbing agent wears off, there may be more discomfort, but try not to worry because we expect this to happen.

In order to help you manage your pain postoperatively, we recommend multimodal pain management. This simply means addressing your pain from multiple angles. We do use medication – both oral and injectable – but we also use ice and elevation and compression and rest. You might have a pain pump or a regional block. We ask that you also take a role in your pain management. This means being resilient and believing you will get through this because you will. Try not to “catastrophize” your pain. It will improve, sometimes sooner than seems possible.

A brief word about narcotics. First, most of us are aware of the opioid addiction crisis in this country. In the last twenty years, it is no secret that they have been over-prescribed. There are now rules in place limiting the number of pills we can prescribe and the frequency with which we can issue these prescriptions. That said, they do play their role early in your recovery to help you get on top of your pain. You may need to take a full dose of your prescribed narcotic regularly to help with the pain initially. Once you are able to get on top of your pain, then you will be able to decrease your dose and frequency. Opioids are addictive – and can cause wicked constipation, among other unpleasant side effects – but if you use them judiciously, and wean off them as you no longer need them, your risk of addiction is minimal. So use them, early.

Complications are an unfortunate possibility following any surgery. The type and severity of the possible complication varies depending on the location and magnitude of your procedure. More complex, longer operations tend to have a higher complication rate. However, there are ways to minimize the risk of a complication happening to you. The types of complications that we tend to consider include blood clots, infection, nerve damage, stiffness, recurrence of the injury, or failure of a repair. Prevention of a complication can take several forms. For instance, we may ask you to take aspirin after your surgery and stay hydrated to reduce the risk of blood clots. Additionally, we may give you antibiotics prior to (and sometimes after) your procedure to help prevent infection. Keeping your dressing and wound clean and dry after surgery for a variable period of time is also typically advised. We often will give you gentle exercises to perform postoperatively to prevent stiffness. Alternatively, we may ask you to refrain from certain activities, even basic tasks such as actively moving the operative extremity, in order to prevent damage to your repair. We will discuss this with you prior to your surgery and afterwards as well. If you have any questions about what you should or shouldn’t do postoperatively, please ask us. Similarly, if you have a concern about how you’re healing or feel you may be developing a complication, we are available 24/7 to answer your questions.

In general, after your surgery you will be asked to keep your dressing or incision clean and dry for some period of time. If you have a plaster splint, you will very likely be asked to keep it in good repair until your first postoperative visit, during which it will be removed. Those of you having arthroscopic procedures are typically asked to keep your incisions (or portals) clean and dry for a week. Waterproof band-aids work well for this. In between showers, wearing a regular band-aid will allow your incisions “to breathe” which aids in healing. After a week, you can typically get your small incisions wet in the shower, provided they’re healing uneventfully. Joint replacement patients are typically given an occlusive dressing that contains an antiseptic that can stay on for 2 weeks before being changed. These dressings are water resistant but not waterproof, so it is advised you cover them in the shower with a plastic wrap. As a general rule, any time you change a dressing or come near your wound, make sure you wash your hands well first. Antibiotic ointments and creams are not necessary for healing. Sutures are typically removed at your first postoperative visit, usually at around 10 days following surgery.

Regarding your sling (if you have one), we will want you to wear it most of the time, at least initially, coming out of it to perform your range of motion services or to bathe. It serves as a reminder to you not to overuse your extremity and as a warning to others that you’ve recently had surgery. The small pillow that is part of the sling brings your arm slightly away from your body, which takes tension off of your repair, aiding the healing process. If you must take your sling off, it is advised you rest your arm on a pillow to help with healing. Tucking a dry wash cloth under your arm can help prevent a “heat rash” from forming. As time goes on and the healing process proceeds, you will be allowed out of your sling more and more. In the meantime, please bear with your surgeon as there is a reason we are asking you to wear your sling.