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After Surgery

General Post-Operative Instructions  |   Printable Instructions   |   Additional Information  



Before you leave the center, you will be given written instructions for your care at home.

After you have returned home, be sure to follow your doctor's orders regarding diet, rest, medication and activity. By the next day you should be back to your normal diet. It is not unusual to feel a little sleepy, lightheaded or dizzy for several hours after your operation.
Do not sign any important papers or make any significant decisions for at least 24 hours.

If you have any questions or problems after surgery, please contact your doctor.

Do not drive a car, smoke, drink alcoholic beverages, operate machinery or cook for 24 hours after surgery.

GENERAL POST-OPERATIVE INSTRUCTIONS

  • You will need someone to take you home from the Surgery Center following your surgery. Most patients are in the recovery room for approximately 60 minutes following surgery and are then ready for discharge. You should have someone stay with you for the first 24 hours after your surgery. 
  • You will need to rest on the day of surgery. On the following day you may do those activities that you feel able to do OR AS INSTRUCTED BY YOUR DOCTOR.
  • If you have had anesthesia or sedation you may feel dizzy, light-headed or sleepy for 12 to 24 hours after your surgery. This is perfectly normal. You should not drive, operate any mechanical or electrical devices, drink any alcohol or make any important decisions for 24 hours. After a general anesthetic it is normal to feel a generalized aching and to have sore muscles for 24 to 48 hours, A sore throat may also occur.
  • You may resume your diet gradually beginning with liquids and progressing as you feel ready.
  • You will need to get your pain medication prescription filled as soon as possible after surgery if you have not done so before surgery. There is no pharmacy in the Surgery Center.
  • You will need to keep any dressing you may have clean and dry for however long your doctor prescribes. Plan your activities of daily living after surgery with this in mind.
  • If surgery was done on arms or legs you will need to keep the extremity elevated. Make sure you have enough pillows to accomplish this.
  • You may be required to intermittently put ice on your surgical site. Be sure to have ice (or frozen peas or corn) available. 


PRINTABLE INSTRUCTIONS  (in pdf format )

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ADDITIONAL INFORMATION 

It is very important that you are well prepared for your upcoming surgery.
We have put together information in this section of our web site that you should review in the days prior to your surgery.

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Pain Management  
In the PACU/Recovery Room you will be asked to rate your pain.

This helps us to objectively evaluate how much discomfort you are having.
The scale that we most often use is the 0 -10 scale.
0 is no pain and 10 is the worst possible pain.

At Home 

It is best to have someone stay with you after you arrive home from your surgery. If this is not possible, we recommend that you arrange to have someone available by phone.

    • Some patients have concerns about taking care of themselves when they go home. Please discuss these or any concerns you may have with your nurse during your preoperative interview. 
    • A nurse from the recovery room will try to call you the day after your procedure to see how you are doing and answer any of your questions. 
    • If you need to speak to a nurse, you may call the Surgery Center at (415)346-1218 . A nurse is available Monday through Friday .
    • Your surgeon is available to you as well. You can reach him/her at their office or they can be paged through their answering service.

It is important that you fill the prescription for your pain medication.

    • Patients are often comfortable when leaving the surgery center and do not think they will need anything as strong as a prescription pain pill. 
    • Many surgeons use local anesthesia at the wound site so that you will be fairly comfortable until the local anesthesia wears off, which sometimes does not occur until later in the day or even into the next day. 
    • It is much easier to keep your pain under control than try to alleviate it with more medication once you are very uncomfortable. We recommend that you fill your prescription as soon as possible. 
    • It is often helpful to fill your prescription before your day of surgery. Please bring your insurance card with you.

Take pain relief drugs when pain first begins  

    • It is much easier to control your pain when you take your pain medication as prescribed.
    • Most patients on the day of surgery, that evening and the following day will need to take their pain medication every 4 to 6 hours
      • As your discomfort lessens you may change taking your prescription narcotic medication to a Tylenol or ibuprofen like drug as ordered in your discharge instructions
      • As long as you are taking narcotic type medication you should not drive, drink alcohol or do anything that requires coordination or judgement activity
    • If the pain medication prescribed for you is not effective in alleviating the discomfort, you should contact your surgeon.  
    • Please follow the advice of your surgeon if ice and/or elevation to the surgical area is recommended.

Some pain medications can cause constipation  

    • If this happens, you may take a stool softener (such as Colace), or a gentle laxative (such as Milk of Magnesia).
    • You do not need a prescription for these medicines.

Do not drive while you are taking "narcotic" pain medication.

    • This includes medicine like Percocet, Tylenol #3, and Vicodan.

Prescription Pain Medications and Non-Narcotic Pain Medications

Below we have provided general information about some of the commonly prescribed pain medications. The information provided here does not contain a full description of the medication listed. For specific medication information, such as dosage, adverse effects, side effects and possible contraindications, please consult your pharmacist.

All of these medications are best taken with food in your stomach such as a few crackers or toast. 

Non-Narcotic Pain Medications

Tylenol/Acetaminophen 

    • Benefits:
      • These medicines reduce swelling, fever, inflammation and mild to moderate pain after surgery.
      • They can lessen or eliminate the need for stronger medications. 
      • NSAIDS can be used alone or in combination with narcotic pain medication to help control more severe pain.
      • They are not addictive. 
    • Risks:
      • NSAIDS can interfere with blood clotting.
      • They may cause nausea, vomiting, stomach pain and heartburn. 
      • Check with your doctor or your discharge instructions before taking this medication.

Narcotic Pain Medications

(A prescription is necessary for these medications. These medications may not be refilled.)

    • Tylenol #3 (Tylenol with Codeine)
    • Vicodin (Hydrocodone) 
    • Percocet/Roxicet
    • Demerol

Benefits: 

    • Most often used for acute pain such as short-term pain after surgery. 
    • They do not cause bleeding. 
    • It is rare for patients to become addicted as a result of taking narcotics for post-operative pain.

Risks:

    • Narcotics may cause drowsiness, nausea, constipation, itching, or interfere with urination.
    • Some of these medications contain acetaminophen (Tylenol). If you have liver disease, consult your doctor before taking this medication.
    • Do not take more medication than prescribed by your doctor.
    • Do not drink alcoholic beverages while taking these medications.
    • If you are taking the medication as directed and you do not have pain relief, please call your doctor.

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Operating Room  
Who will be in the operating room with me? 
         Your peri-operative team consists of your surgeon and their assistants, nurses, anesthesiologists and a surgical technician.

Where do I go to sleep? 

         You will be prepared for your surgery in the pre-operative holding area where you may receive some sedation to reduce your anxiety and make you sleepy. Your anesthesia will be administered in the operating room.

How do I get to the Operating Room?

         You will be transported on a stretcher accompanied by your anesthesiologist and nurse. Once in the room you will be assisted in transferring to the operating room bed.

How will I be positioned in the operating room?

         The operating room team will assist you to a comfortable position on the operating room bed. If you have back problems or difficulty lying flat, please let the nursing staff know so we can take extra care in positioning you for your surgery.


Why is the operating room so cold?

         The operating room temperature is kept low for several reasons: the maintenance of our equipment, the sterility of our supplies, for the comfort of your surgical team who are required to wear long sterile gowns and work under hot lights. We provide you with warm blankets as soon as you are settled in the operating room.

Will I be able to see my surgery being performed?
         We find it best for our patients not to see the actual procedure. If you chose a type of anesthesia where you are awake, the operating room team will keep you informed of the progress of your surgery.

Why is there so much equipment in the room?

         Our ambulatory operating rooms are fully equipped for all types of surgical procedures. This means that much of the equipment and supplies you see may not be necessary for your procedure.

Are family members allowed into the operating room?

         Family members are not allowed into the operating room for safety and sterility reasons. If your family member does not speak English or has communication difficulties, an interpreter will be provided who has been trained to assist the operating room staff.

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Recovery Room  

The PACU, post anesthesia care unit or recovery room, is the name of the room where you will recover from your surgery and anesthesia. An experienced post anesthesia care nurse and anesthesiologist will be there to care for you during this time.

Frequently Asked Questions About the Post Anesthesia Care Unit

What happens in the PACU/Recovery?

  • During your recovery you will be placed on a heart monitor that continuously monitors your pulse and blood pressure.
  • A finger cover is placed on your finger. It tells us how much oxygen is in your blood and how well you are breathing.
  • Your temperature will be taken by placement of a small probe in the outer ear canal. It is a quick way to check your temperature. You will feel a slight pressure in your ear when this is done.
  • When you first wake up you may have an oxygen mask covering your mouth and nose. It is important to keep it on until your nurse removes it.
  • If you have an incision or bandage, your nurse will be checking the area for any bleeding. 
  • When you are awake and ready for fluids, you will start drinking small sips of water.

How will I feel after surgery?

  • You may feel sleepy, dizzy and/or forgetful from the medications given to you during your operation. These feelings will improve as time passes.
  • You may have some discomfort after your surgery. The nurses will give you medication to make you feel better.
  • If you have had a spinal anesthetic or a nerve block to an extremity, the extremity will feel numb and heavy and you may not be able to move it. This is not cause for worry. The normal feeling and movement will return with time as the medication wears off.

How long will I be in the PACU?

  • The average recovery time is usually between 30 to 90 minutes. Since each person is unique recovery time will vary.
  • You can be discharged home when you are reasonably comfortable, awake and alert, pain is manageable and you have minimal nausea.

Will someone explain to me what I should do when I get home?

  • Before you are discharged home, the nurse caring for you will review your discharge instructions with you and your family.
  • All of your questions will be answered before you go home.
  • Our phone number will be given to you to call if you have questions.
  • Always feel free to call your surgeon for any questions or problems.
  • If you do not know your surgeon's phone number, please call the Surgery Center @ (415) 346-1218.

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Wound Care  
You will receive specific instructions about how to care for your wound from your surgeon. These instructions will be found on your discharge instruction sheet given to you on the day of surgery. This page has additional information that you may find helpful for taking care of your wound.
  •  You should check the dressing for any drainage. A small amount of clear or light red staining is normal.
    • If the dressing becomes soaked with bright red blood you should call your surgeon.
  • Mild swelling along the incision is normal.
    • If you should experience any increase in swelling, pain and/or firmness around the surgical area, call your surgeon. 
  • It is normal to feel a ridge along the incision; this will go away.
  • You may remove your dressing when directed by your surgeon.
    • Most patients will remove their dressing within one to three days of surgery. You will find information about your dressing in your discharge instruction sheet.

To Remove The Dressing:
** Always wash your hands first with soap and water**

  • Remove the outer dressing. 
  • DO NOT REMOVE the steri-strips (the thin paper strips that are on your incision) they will fall off on their own.
  • Some patients find it easier to remove the dressing in the shower where the tape comes off more easily.
  • The dressing should remain dry until you are allowed to shower. Baths should not be taken until your surgeon has said that you may do so. The wound should be gently washed with plain soap and water. Pat the incision dry.

For Best Wound Healing:

  • Maintain good nutrition; eat a well balanced diet.
  • Do not smoke .
  • Watch the incision for signs and symptoms of infection .
  • Keep your incision dry.
  • Do not use deodorants, powders, lotions or sprays on/or near the incision. 
  • Do not use any ointments on your incision unless you were told otherwise.
  • Do not expose incision to sun. Once incision is fully healed use sunscreen over the incision.
  • Follow your doctor's instructions.

Signs and Symptoms of wound infection:
**If you have any of these signs or symptoms call your surgeon**

  • Redness around the incision that is spreading . (It is normal for the area around your incision to be slightly red). 
  • Increased warmth and swelling around the incision . 
  • Increased tenderness and pain. 
  • Foul smelling drainage. 
  • Temperature of 101 degrees or higher and/or chills.

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Other Resources

 

For your convenience we have put together a list of web sites which may be relevant to your ambulatory surgical experience. This list is not exhaustive but rather represents a small selection of the many related web sites available.

Agency for Healthcare Research and Quality
ConsumerHealth
http://www.ahcpr.gov/consumer

American Society of Anesthesiologists
http://www.asahq.org/

American Society of PeriAnesthesia Nurses (ASPAN)
http://www.aspan.org/

Association of Operating Room Nurses (AORN)
http://www.aorn.org/

Healthfinder
Consumer Health and Human Services government website
http://www.healthfinder.gov/

Oncolink
University of Pennsylvania Cancer Center
http://cancer.med.upenn.edu/

Pain Control after Surgery A Patient's Guide
Agency of HealthCare Policy and Research: Consumer Health
http://text.nlm.nih.gov/

When You Need an Operation
American College of Surgeons
http://www.facs.org/public_info/operation/wnao.html

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Food and Drug Interactions

 

The following text has been prepared for you by Food and Nutrition Services and Pharmacy Services. It contains information about some common interactions that may occur between the food and drugs that you take. It does not attempt to discuss all possible food and drug interactions, nor does it list all possible food and drug interactions. For information regarding food and drug interactions, consult your pharmacist or doctor.

Analgesics Aspirin and Nonsteroidal Anti-inflammatory Drugs (NSAlDs)

Aspirin, other salicylates (TriJisate, Disalcid, Dolobid)
Ibuprofen (Advil, Morrin, Nuprin and various other brands)
Ketoprofen (Orudis KT)
Naproxen (Aleve, Naprosyn, Anaprox)
Other NSAlDs (Indocin, Clinoril, Daypro, Feldene,
Lodine, Relafen, Toradol, Voltaren, etc.)

These agents may cause stomach upset and should be taken with milk or food. Do not take these drugs with anticoagulants such as Coumadin without discussing risks with your doctor or pharmacist. Gastrointestinal bleeds may result with improper or excess use.

Narcotic Analgesics

Morphine
Codeine
Meperidine (Demerol)
Percocet
Percodan
Vicodin, other narcotics
These drugs may cause drowsiness, constipation and stomach upset. Take with milk or food. Avoid alcoholic beverages.

Phenazopyridine (Pytidium)
Take 1/2 hour before meals with a full glass of water. This drug may change the color of your urine.

Antibiotics

Cephalosporins (Cedor, Ceftin, Keflex, VeloseD
For best results, take on an empty stomach (l hour before meals or 2 hours after meals). If stomach irritation occurs, take with milk or a light snack (i.e. crackers).

Erythromycins (E-mycin, Erytab, EryC, Biaxin, Zithromax)
Take on an empty stomach or immediately before meals. Avoid taking with citrus foods, citrus juices and carbonated beverages.

Metronidazole (Flagyl)
This drug may cause stomach upset. Take with food. Avoid alcoholic beverages while taking, otherwise nausea and vomiting may occur.

Nitrofurantoin (Macrodantin)
This drug may cause stomach upset and change the color of urine. For best results, take with milk or food.

Penicillins (PenG, Pentids, Ampicillin)
Take on an empty stomach (l hour before meals or 2 hours after meals). Take with a full glass of water. Avoid taking with citrus foods, citrus juices and carbonated beverages.

Amoxicillin
Pen VK
Augmentin
Absorption is unaffected by food.

Quinolones (Cipro, Floxin, Noroxin)
Avoid antacids 2 hours before and up to 3 hours after taking medication. Take with a full glass of water.

Tetracycline (Sumycin)
Avoid iron and calcium supplements, antacids, milk and milk products. For best results, take on an empty stomach (1 hour before meals or 2 hours after meals).

Anticoagulants

Warfarin (Coumadin, Dicoumarol)
Avoid alcoholic beverages. Maintain a consistent diet of foods containing vitamin K (see foods high in vitamin K chan). Check with your doctor before taking aspirin, aspirin-like products and nonsteroidal anti-inflammatory agents (NSAIDs) such as Advil, Motrin and Aleve.

Gastrointestinal Preparations

Diphenoxylate (Lomotil)
Avoid alcohol or other depressants such as tranquilizers or sedatives.

Metoclopramide (Reglan)
Take 1/2 hour before meals. This drug may cause drowsiness. Avoid alcoholic beverages.

Cimetidine (Tagamet)
Take before meals. Stagger doses of antacids.

Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)
Absorption is unaffected by food.

Omeprazole (Prilosec)
Lansoprazole (Previcid)
Take before any meal.

Laxatives (Colace, Metamucil)
Take with 8 ounces of water.

Miscellaneous
Antihistamines (Benadryl)
This drug may cause stomach upset and frequently causes drowsiness. Take with food. Avoid alcoholic beverages.

Corticosteroids
Prednisone (Deltasone)
Prednisolone (Delta-Cortef)
Hydrocortisone (Cortef)
May cause stomach upset. Take with milk or food.

Food Information List

This list is not entirely inclusive. For more information please consult your dietician or doctor.

Foods high in
vitamin K
      Food high in
potassium
      
Vegetables
     
Other

Asparagus
Broccoli
Brussel sprouts
Cabbage
Cauliflower
Dark lettuce
Varieties
Garbanzo beans
Green beans
Green peas
Green tea
Liver
Soybean oil
Spinach
Turnip greens
Vegetable Oils

Fruits
Apricots (dried)
Banana
Cantaloupe
Dates
Dried fruit
Figs
Honeydew
Kiwi
Nectarine
Oranges (juice)
Papaya
Pomegranate
Prunes (juice)
Pumpkin
Raisins
Rhubarb

Vegetables
Artichokes
Asparagus
Avocado
Bamboo shoots
Beans, dried
Broccoli
Brussel sprouts
Carrots
Celery
Parsnips
Peas
Potatoes
Spinach
Squash
Sweet potatoes
Tomatoes (juice)

Bran cereal
Chocolate
Milk
Molasses
Salt substitute
Swiss chard












Drug affect by grapefruit juice

Recent studies have shown that grapefruit juice may interact with the metabolism of some drugs. For further information please consult with your doctor.

Consider avoiding grapefruit juice with the following medications:
Felodipine
Nifedipine
Nimodipine
Nisoldipine
Verapamil
Caffeine
Cyclosporine
Erythromycin
Estrogens
Midazolam
Terfenadine

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HERBAL USE AND ANESTHESIA

 

What you should know Herbal Use and Anesthesia.

Name of Herb

Common Uses

Possible Side Effects or Drug Interactions

Echinacea

Boosts the immune system and helps fight colds and flu; aids wound healing

May cause inflammation of the liver if used with certain other medications such as anabolic steroids, methotrexate or others

Ephedra
(also called Ma-Huang)

Used in many over-the-counter diet aids as an appetite suppressant; also for asthma or bronchitis

May interact with certain antidepressant medications or certain high-blood pressure medicines to cause dangerous elevations in blood pressure or heart rate. Could cause death in certain individuals.

Feverfew

Used to ward off migraine headaches and for arthritis, rheumatic disease and allergies

May increase bleeding, especially in patients already taking certain anticlotting medications.

Garlic

For lowering cholesterol, triglyceride levels and blood pressure

May increase bleeding, especially in patients already taking certain anticlotting medications.

Ginger

For reducing nausea, vomiting and vertigo

May increase bleeding, especially in patients already taking certain anticlotting medications.

Ginkgo
(also called ginkgo biloba)

For increasing blood circulation and oxygenation and for improving memory and mental alertness

May increase bleeding, especially in patients already taking certain anticlotting medications.

Ginseng

Increases physical stamina and mental concentration

May cause decreased effectiveness of certain anticlotting medications. May see increased heart rate or high blood pressure. May cause bleeding in women in women after menopause.

Goldenseal

Used as mild laxative and also reduces inflammation

May worsen swelling and/or high blood pressure.

Kava-kava

For nervousness, anxiety or restlessness; also a muscle relaxant.

May increase the effects of certain antiseizure medications and /or prolong the effects of certain anesthetics. Can enhance the effects of alcohol. May increase the risk of suicide for people with certain types of depressions.

Licorice

For treating stomach ulcers.

Certain licorice compounds may cause high blood pressure, swelling or electrolyte imbalances.

Saw Palmetto

For enlarged prostate and urinary inflammations.

May see effects with other hormone therapies.

St. John’s Wort

For mild to moderate depression or anxiety and sleep disorders.

May prolong the effects of certain anesthetic agents.

Valerian

Mild sedative or sleep-aid; also a muscle relaxant.

May increase the effects of certain antiseizure medications or prolong the effects of certain anesthetic agents.

 

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