Postoperative Care

Postoperative Care

Our Colorado Neurosurgeon Can Improve Your Standard of Living

Prior to surgery patients may spend considerable time preparing for surgery. Preparations often include learning about the procedure and recovery, preoperative testing, and organizing the household for aftercare.

But what happens immediately after surgery, when the procedure is over?

  • The Recovery Room
    Postoperative recovery starts in the Post-Anesthesia Care Unit (PACU). This unit is dedicated to meet the patient’s needs, thereby minimizing postoperative complications.
  • Anesthesia and Waking Up

    Although it may only have taken moments to surrender to general anesthesia, recovery from anesthesia takes time. Throughout the surgery, the anesthesiologist maintained deep sleep. During this time, muscles and fat absorbed some of the anesthesia, which helped to maintain levels of anesthesia in the brain and blood.
    It takes time for anesthesia to be eliminated from the body’s tissues. Many factors affect the amount of time a patient may spend in the PACU. These factors include the pre-operative medication, the type of anesthetic, and the length of time an anesthetic was administered during surgery.

    Your hearing is the first sense to return following general anesthesia. This is why the PACU staff speaks in a reassuring tone while letting the patient know what they are doing.

  • Assessing Patient Needs and Vital Signs

    In the PACU, the patient may wear certain devices to automatically monitor their vital signs. These devices include a blood pressure cuff, oximeter (records pulse), and EKG leads (monitors the heart). The IV remains in place to deliver medication and fluids intravenously. A urinary catheter collects urine to help the nurse monitor kidney function and hydration after many spine surgical procedures.

    Every few minutes, a nurse assesses the patient’s overall condition. This helps to minimize postoperative complications. In addition, the nurse will place warm blankets around the patient’s body. It is common for patients to feel cold following surgery.

  • Proper Breathing

    Lying flat for long periods of time can cause fluid to accumulate in the lungs. The nurse helps the patient to sit up to breathe deeply and cough. This loosens secretions for elimination and helps to prevent pneumonia.

    Deep breathing increases circulation and promotes elimination of anesthesia.
    Some patients are instructed to breathe into a spirometer. A spirometer is a device used to measure how deeply a patient is able to breath (e.g. lung capacity) and acts as an incentive so you will see just how deeply you are breathing.

  • Post-Operative Monitoring

    These are Problematic and Concerning Symptoms:

    • Fever greater than 100.5° F after 3 days from surgery with associated chills and/or night sweats
    • Increasing redness, fluctuance, warmth, swelling, and/or foul-smelling drainage from surgical site
    • Opened wound from failed suture or staple sites(s) – greatly increases the risk for infection
    • No fresh blood, yellow or greenish discharge should be present
    • Chest pain, shortness of breath, pain in the neck or arm
    • Increasing numbness or weakness, especially in the groin areas
    • Changes in bowel or bladder function, burning or itching with urination
    • New calf or leg pain

    If you experience any of these symptoms, you must contact our clinic immediately!

    Please Note: If your symptoms as noted above are worsening and it is after clinic hours:

    • Contact our on-call doctor at (720) 441-4021
    • Go to the Emergency Department at the nearest hospital and have the attending physician phone or page our physician on call to discuss the issue at hand

    We are not able to examine you over the phone!

    These are Routine Concerns:

    • Skin Irritations
    • Itching and/or irritation from tape adhesives
    • You may use antihistamines such as Benadryl or equivalent
    • You may lightly cleanse the affected area, but not the incisions, with mild soap to remove the irritant. Recommended cleansers are Exidine, Hibiclens, Phisoderm or equivalent
    • You may apply ice to the area
    • Do not use heat as heat will worsen the condition
  • Wound Care

    You may start showing the day after your surgery allowing the water to run over the incision; wash with soapy water, rinse, and pat dry. Do NOT recover the incision with a dressing/gauze. Please do NOT attempt to remove any sutures, staples, or Steri-Strips that might be present. These will be removed in our office at your first postoperative visit.

    Do not apply any ointments, lotions, creams, or powders to your incision.
    NO baths, hot tubs, Jacuzzi, or swimming until your wound is completely healed and you have been cleared by your physician. Wounds must be 100% closed prior to being submerged in water.

    Have someone check your incisions daily for signs of infections, i.e., increasing redness, warmth, pain, yellow or green or foul-smelling drainage, fever greater than 100.5°.

  • Postop FAQs

    When do I need to be seen in the clinic?

    • Your first office visit should occur at 10-14 days after surgery. If you have been on the rehabilitation unit and have, therefore, been in the hospital longer, you should be seen in the clinic 14 days from the date of your discharge.
    • Please schedule a follow-up appointment accordingly. Call for your appointment today!

    How do I manage my constipation after surgery?

    • This is a routine problem after surgery and with narcotic medication use
    • Prevention is the key
    • Start the following over the counter regimen as soon as you get home. Use each category together:
      • Colace or Pericolace, 100mg tablet, twice a day ALONG WITH Milk of Magnesia, 30CC once a day
      • Citrucel or Metamucil fiber supplements, twice a day
      • Use a stimulant such as Senekot-S, Dulcolax suppository or Fleet enema or equivalent if you have not had a bowel movement after several days
      • Continue this regimen for two weeks or as needed. If you experience diarrhea, you may back off the remedies.

    What activities are permitted or restricted when I first get home?

    • You will require frequent periods of rest. Fatigue is normal for the first 3 months
    • Walk as much as tolerated. There are no limitations, but you should listen to your body and rest when you are tired.
    • Your exercise is limited to walking or using a treadmill and/or stationary bike.
    • Limit sitting to 30 minutes at a time, no more than 4 times a day. Sitting for long periods will tend to make your back sore.
    • Limit lifting to 20 pounds maximum
    • Use your lumbar corset/brace
    • When you feel you are ready, you may begin to wean yourself from use of the lumbar corset, walker or cane
    • Do not lift, stoop, bend or twist more than 20% of your normal range
    • Drive when you feel ready but never under the influence of medications!
    • Use a position of comfort and control when you feel you are ready to begin sexual activity
    • Use common sense with all of your activities

    What should I know about my medications before and after surgery?

    • Narcotics and controlled substances, muscle relaxers and/or sedatives are potent pain medications
    • They are used to control acute surgical pain and other pain syndromes
    • They have a high potential for psychological dependence (addiction) and/or physical dependence (tolerance/dependence)
    • Do not drive, operate heavy machinery or dangerous equipment or perform executive or critical decisions. The medications you may be using can cause sedation or cognitive/motor impairment. Resume these activities if you can function without any physical impairment and if you have stopped taking the medications or they do not impose any unsafe side effects or risks.
      • Stopping pain medication abruptly may lead to withdrawal symptoms. You may experience:
      • Insomnia, irritability, agitation, headache, tremors, sweating, racing heart, runny nose or eyes, diarrhea, hot flashes, poor appetite and increased pain
      • These symptoms usually last 3-7 days depending on the medication and dosage
      • We recommend that you gradually reduce your dosage with these medications
    • Remember that various pain medicines can only be picked up in person at the pharmacy. Prescriptions for these medicines cannot be called in or faxed over to pharmacies. We expect you to adhere to the clinic prescription-medication-refill policies and agreements.
    • If these medications are required longer than necessary for chronic pain well after surgery:
      • You will be referred to either your primary care physician or to a pain specialist to continue pain management
      • We do not manage chronic/long-term pain
    • Do not take medications/substances that have not been authorized by a physician
      • This includes over the counter remedies, herbal supplements, etc.
      • Constipation will exacerbate your spine pain. Please follow the bowel protocol outlined above.
      • Over the counter stool softener and fiber are recommended while you are taking pain medication
    • Spine Fusion Patients Only: Avoid Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), steroids and cytotoxic drugs (rheumatoid/anti-cancer agents) for the first 3-6 months since these may inhibit bone growth. The literature is controversial, but we prefer to be conservative.

    Other Concerns

    • Use care when using stairs, walking on uneven surfaces, snow, ice or anything that could promote a fall, especially within the first 6 months of surgery
    • A fall or other trauma has the potential of disrupting the surgical work performed on your spine
    • You may discontinue the TED hose/stockings one week after surgery only if you are walking frequently throughout the day

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