Nathan WM. Skelley, M.D.

How long will surgery take?

SURGERY IS AN ALL DAY EVENT--do not make other appointments, work, or errands on your surgery day. Discuss with Dr. Skelley how much time you should take after your surgery to rest and recover before returning to work or activities.

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What do I need to bring with me the day of surgery?

• Photo ID and insurance card

• Dress appropriately

  • Loose fitting front closure shirt/blouse/sweater or a front zip so you can easily change into a hospital gown

  • Warm up jacket, coat, or sweater

  • If you wear glasses, bring them. Do not wear contacts lenses to surgery.

• Friend or family member who is able to drive you and help get you home

• Pillow for comfort/sleeping on your way home

• Crutches or a walker if you have them already

• If you are having a joint replacement

  • You should bring any personal items that will keep you comfortable for the 1-2 days that you will be in the hospital.

 

What should I leave at home?

• Jewelry - especially valuable jewelry such as wedding bands

• Valuables such as tablets and laptop computers.

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Check-In

At Sanford Surgical Center you may park in the parking garage across the street and will check in at the front desk once entering the building. The specific time will not be given to you during your office visit. You will receive a phone call 1-2 days prior to surgery. Try to arrive at or before your scheduled time the day of surgery, as any delays may result in cancellations. You will be asked to arrive before your actual surgery time to allow for the registration process, preoperative testing, and consultation with the anesthesiologist. After you have registered, a nurse will check you in to the holding area. You will be asked several questions about your medical history, they will take your vital signs, and you will be asked to change into a hospital gown.

 

Anesthesia

The nurse will start an intravenous (I.V.) line which will be used to deliver medications to your bloodstream during and after surgery. Immediately before surgery the anesthesiologist will discuss the details of your anesthetic. Any questions you have regarding anesthesia, including nerve blocks available for pain control, should be addressed with the anesthesiologist.

 

Surgery

After you have been prepared, the nurse from the operating room (O.R.) will take you to the surgery area. You will be asked to wear a surgical cap to cover your hair. After being checked in a second time you will be wheeled into the operating room. You will be asked many of the same questions on several occasions. This is to prevent any important information from “slipping through the cracks."

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The surgical team is composed of your surgeon, Dr. Skelley, his assistants, 2 or 3 nurses or surgical technicians and the anesthesiologist. The temperature in the room is typically lower than normal and warm blankets will be provided. Once the anesthesiologist is prepared, he or she will administer medicine which will make you feel relaxed. Afterwards, more medicine will cause you to fall asleep. Surgical time varies from case to case but we will make a time estimate for your family so they can prepare appropriately. After surgery Dr. Skelley will talk with your family members about the surgery and the rehabilitation protocol after surgery. Please make sure that family members are available at this time.

 

Post-Anesthesia Recovery Unit (PACU)

When you awaken from the anesthetic, you will be in the PACU. A nurse will be assigned to monitor your progress and address your needs. After you have stabilized, you will be transferred to your room or the second stage recovery area in preparation for discharge. It is only at this time that your family members will be able to see you. Family members are usually not allowed in the main recovery room because of the need to maintain privacy of the other patients.

Medications and Pain Management

Immediately after surgery, your friends or family members will be given your post-operative prescription for pain medication. Remember for the first 24 to 48 hours to stay ahead of your pain with the medication and take it on a scheduled (regular) basis. Don’t be afraid to take your medication regularly during this time, as some pain is expected after surgery.

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The following is a list of common medications prescribed:

Narcotic pain relievers (i.e. Vicodin, Oxycodone, Norco).

These medications alter your perception of pain. They can make you feel sleepy therefore you should not drink alcohol, drive, or operate machinery when taking them. Narcotic pain relievers can cause nausea, particularly if taken without food. Always take your medications with food. Additionally, some patients will notice constipation. To minimize this be sure to drink plenty of fluids, especially fruit juices. Once your pain has reached a more manageable level, you may switch to using an over-the-counter medication (Tylenol, Ibuprofen) as directed.

 

Anti-inflammatory medications (i.e. Ibuprofen, Naproxen, Toradol).

These medications help with swelling, stiffness, and pain. They can cause stomach upset and rarely ulcers. They too should be taken with food. If stomach irritation occurs, Pepcid AC or Prilosec OTC can be taken in conjunction with the medications. If stomach irritation persists, or if you notice blood in your stools, immediately discontinue the medication and call our office.

 

Stool softener (i.e. Docusate/Colace, Sennakot/Senna)

You may be given a prescription for a stool softener This medicine is meant to be taken while you are taking narcotic pain medications in order to prevent constipation. You no longer need to take this medication when you are no longer taking the narcotic pain medications.

 

Nausea Medication (i.e. Zofran, Ondansetron)

You may be given a prescription for Ondansetron if you are prone to nausea or have a known reaction to one of the pain medications. You can take this medication on an as needed basis if you are having nausea after surgery. Please call our office if you have persistent nausea after surgery.

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Postoperative Care immediately after surgery:

Wound Care

In surgery, we apply a sterile dressing sealed with a plastic protective covering or tape bandage. You will be given instructions on specific wound care management and dressing changes in your discharge instructions after your surgery.

 

Ice

It is normal for you to have swelling after surgery. Ice and elevation are the easiest ways to decrease swelling. It is important for you to use ice several times a day during the first week after surgery. You will have an ice wrap or mechanical ice unit after your surgery. Here is a simple, inexpensive way to make extra lightweight ice bags.

1. Wet some towels (hand or kitchen sized work well)

2. Ring the towels out slightly

3. Fold each towel into a small square (6 inches works well)

4. Place each folded wet towel into a quart size zipper type kitchen baggie

5. Pour ½ to 1 full bottle of rubbing alcohol onto each towel (alcohol freezes as a gel, not rock hard) and zip shut

6. Put into freezer

These can be refrozen many times. Remember do not place the ice directly against uncovered skin, always have a barrier between your skin and the ice such as an Ace wrap or dry towel.

 

Physical Therapy/Home exercises

At some point, you may be given physical therapy or home exercises, which will be individualized based on your type of surgery and any special circumstances. Therapy is every bit as important to your recovery as the surgery itself. Be sure to perform your exercises diligently as instructed. If you are scheduled to stay overnight, a physical therapist may be assigned to see you the next morning to do therapeutic exercises at your bedside.

 

Sleeping

You may notice trouble getting comfortable at night after surgery. This can last several days to weeks. You may sleep on the operated side; this will not damage anything repaired during surgery. However, you should try to avoid this for a while because it will be uncomfortable. If you had shoulder surgery, you may find it more comfortable to sleep in a recliner or upright chair for the first week after surgery.

 

Common Problems

Pain

Some degree of pain is anticipated with any surgery. Once you have begun to experience the pain, treat it promptly and stay ahead of the pain by regularly taking pain medication. A common mistake is to wait too long between doses because the pain level seems reasonable. The medicine works much better to prevent pain than treating the pain once it has occurred. Take it regularly for the first 24-48 hours.

 

Remember some pain is normal. However, your pain should diminish day to day. If you notice worsening pain after several days, call the office.

 

Nausea and Vomiting

Nausea and vomiting can occur for several reasons. In the first 24 hours, the anesthetic agents you received during surgery can make you nauseous. The anesthesiologist typically administers anti-nausea medications, however, patients can still become nauseated. If you experience nausea at home it may be related to one of your pain medications. All of the narcotic medicines (i.e. Vicodin, Oxycodone, Percocet, Norco) can cause nausea, particularly if you taken them on an empty stomach. Never take your pain medicine on an empty stomach. Once you become nauseated, you may not be able to take oral pain medications. An anti-emetic (nausea medicine) may be given to you with your other prescriptions. If so, you may take it as directed should you develop nausea or vomiting.

 

Change in Appetite and Bowel Habits

A temporary loss of appetite is observed in some patients. This is typically short-lived and improves as you recover. Constipation is commonly associated with a decrease in your activity and your pain medications. The narcotics can be especially constipating. You should drink more fluids than usual, especially water and fruit juices, to help prevent this condition. You may also take a stool softener.

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When to Call the Doctor

Fever

A low grade fever below 100ºF is common after surgery. If your temperature goes above 101ºF, especially if it persists after the first 48 hours, please notify our office.

 

Pain

Pain is expected after surgery. Your pain can be aggravated if you fail to take your medicine as directed or if you are overactive after surgery. If your pain is steadily increasing over consecutive days despite normal pain control measures, please notify our office.

 

Wound Care

You should expect some minor bloody drainage to be visible on the dressing. The dressing acts as a wick, therefore, a small amount of blood can make a moderate sized spot on the dressing. If your dressing becomes soaked with blood, or if you notice any purulent drainage, please notify our office.

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Important Numbers

One of the OR nurses will typically call you within 1-2 days after surgery to answer any questions and discuss any problems you may have had in the first few days after surgery. If you have problems before or after that time, please call our office at the Sanford Orthopaedic Clinic. You will be connected with one of our team members or will be asked to leave a message and we will return your call promptly.

• Sanford Orthopaedic Clinic: (605) 328-2663

• After Hours or weekends

  • Sanford Medical Center: 605-333-1000

 

Important Points

1. Stop any herbal supplements and dietary aids 1 week before surgery.

2. We prefer you stop any blood thinners and anti-inflammatories 5-7 days prior to surgery (aspirin, Plavix, Coumadin, ibuprofen, Aleve, Celebrex, etc). You should check with your primary care physician before surgery if you are taking Plavix, Coumadin, or other blood thinning medication.

3. Do NOT eat or drink anything after midnight the night before surgery. This also means NO gum or cough drops.

4. Please wear shorts or loose fitting pants for knee surgery and a button down shirt for shoulder surgery.

5. You MUST have a friend or family member to drive you home after your surgery as you will be unable to drive yourself home.

6. After surgery, we ask that you take your pain medication with food, as prescribed by Dr. Skelley. Stay on top of your pain. Some pain is normal.

7. Perform the exercises given to you after surgery.

8. Do NOT get your surgical dressing wet or submerge your postoperative dressing under water.

9. Call our office if you are having problems.