The First 24 Hours
So, your surgery is finally done and you are resting at home, wondering what is next. This section will take you through the first 24 hrs. Here are some common concerns:
Increased pain- Most patients are given a local anesthetic as well as a regional anesthetic just prior and at the end of your surgery. Every patient responds differently, but on average, the local anesthetic will start to wear off about 4 hours after the end of your surgery. The key to controlling your pain is to anticipate when this would start to wear off and take actions to control the pain. If you graded your pain on a scale of 0 to 10 this would give you an objective measurement of your pain level.
When you start to notice that this pain level is now at level 3, this means the block is starting to wear off. At this time, you should start to supplement your pain management. Normally, this means taking your pain medication. Pain medication works best when taken prior to your pain getting to a high level. Therefore, we recommend taking your medication at the onset of pain instead of letting it get to an 8 out of 10.
Cooling your joint and surrounding tissues can help reduce swelling, bleeding, and bruising. Icing the area all the time for the first 48 hrs is critical in reducing these components of local pain. Obviously, cooling your joint has benefits, but some risks and complications such as skin damage can occur. These risks and benefits must be considered prior to deciding what is going to be the best way to cool your joint. Simple bags of ice can be used, but these MUST NOT be placed directly on the skin. ALWAYS cover the skin with a dry towel to prevent skin damage. The problem with ice bags are that they normally leak. Thus, you can use some frozen vegetables. These last longer than regular ice and they also keep the area cooler over a longer period of time. I normally recommend buying 4 bags. Keep 1 to 2 on your injured area and the remainder in your freezer. Rotate these about every 90 minutes. Make sure you cover your knee with a DRY cloth so there is no direct contact. A normal knee or ankle may accommodate 2 bags while a wrist or hand may only accommodate one. We also have a larger, more efficient device for purchase in our office. You can view the benefits of this device at cryotherapy.
Elevate your Extremity
If swelling in the operative leg is bothersome, elevate the leg for short periods of time throughout the day. After surgery, it is very normal for the extremity to swell. Gravity is a great way to reduce this swelling since all fluids tend to move to seek the lowest force of gravity. This means your legs have to be higher than your heart. It is normally recommended that your legs have to at least 10 cm with the hip bent no more than 45 degrees and the knee bent at 20 degrees. This can be accomplished with the use of a large couch cushion and a smaller bed pillow. Place the larger couch cushion on your bed followed by a standard pillow from your bed on top of the cushion. You should elevate your leg at least twice a day while awake. And during most of the night for the first 2 weeks after surgery. Some patients require more, but this is a bare minimum. Simple ankle pump exercises and calf stretching exercises can help mobilize excessive fluid and stagnant blood in your legs to reduce the chance of a blood clot. These should be done at least 10 times every hour while awake until you are able to walk normally. Here is a link to a video explaining how to perform these exercises: https://youtu.be/GyDEvpxduNc
Whenever there is a skin incision, your body starts an inflammatory response. Providing you with medications and supplements that can reduce this response will help control the pain. The problem with providing this medication and supplements prior to your surgery is the fact that some of these can interfere with the way your blood clots, causing more bleeding during the surgery and more bruising afterwards. Do not take these unless you consider these risks and benefits. The most common is naproxyn sodium, otherwise known as Aleve™ Some other options include Motrin, Nuprin™ and Advil™. To achieve the anti-inflammatory effects of these over the counter medications, you should take the higher doses.
This means taking between 600 to 800 mg of Motrin, Nuprin and Advil (3 to 4 tablets) every 6 hrs. Aleve is taken 2 every 12 hrs. Prolonged use of these medications can lead to some serious side effects such as stomach ulcers, gastro-intestinal bleeding and even kidney failure. So, please consider these risks whenever taking these medications. Many shoulder patients have been given a prescription for an anti-inflammatory called Celebrex and many hip replacement patients have been given Mobic. Taking additional anti-inflammatories may be harmful, so always check with your surgeon before taking these medications.
Surgery can be very stressful as well as the thought of someone else taking care of you. To help, try some deep breathing exercises. Practice some deep breathing exercises such as the 4-7-8 breathing method described in this video: http://www.drweil.com/drw/u/VDR00160/Dr-Weils-Breathing-Exercises-4-7-8-Breath.html
If you are feeling nauseated, this could be due to numerous reasons, but some common reasons after a recent surgery normally focus around the pain medication or a reaction to the anesthesia. To help reduce these symptoms, you can switch your pain medications to non-nauseating forms of medications such as Tylenol™ or Aleve™, but check with your surgeon as mentioned above. Avoiding heavy, greasy and spicy foods can help. Using simple over the counter agents such as Mylanta™ or Tums™may also help for temporary nausea. Your physician may have prescribed a nausea medication for after surgery. Prolonged nausea should be evaluated by either your surgeon or primary care physician.