Robertbrennanmd.com

Post Operative Care

Every operation has a healing process that is similar to the way in which the body responds
to injuries. As such, the corner-stone of this period is analgesia, rest, ice, and gentle
movement.
Analgesia
Pain can be modified through a number of pathways, and medications are tailored
accordingly.
Oxycontin 10mg twice per day by mouth – this is a very powerful orally taken pain killer. I
expect that it will be necessary for up to five days, but often may only be required for one or
two days. Its main side effects are drowsiness and constipation. If drowsiness is a big
problem, spread out the time between doses, or take only at night time. I recommend
drinking more water and having more fruit as safe ways to prevent constipation. When you
no longer need these tablets, safely dispose of them or return them to your pharmacist for
disposal.
Naprosyn SR 1000mg or 750mg daily – this is a long lasting non-steroidal anti-inflammatory
drug (NSAID) that I have found to work very well. Like most medicines, it may upset your
stomach and trying a different timing related to food or a different brand can help. On rare
occasions, stomach anti ulcer medication is taken if a NSAID is absolutely necessary.
NSAIDs should be avoided if you have a known peptic ulcer.
Paracetamol (Panadol) 500mg x2 four hourly – regular paracetamol its by itself is very
powerful analgesic medication. It has minimal side effects and is often combined with
codeine for extra analgesic effect. These include Panadeine and Panadeine Forte. It is very
important not to take Panadol and/or Panadeine and/or Panadeine forte together on a four
hourly basis – this would double your paracetamol intake and would be dangerous.
Rest
If you have been provided with a sling or brace, this is to remind you and others to rest the
affected limb. Pain is reminding your body to do this, but we are modifying this with the
analgesia. The sling or brace also has a protective effect if a tendon or ligament repair has
been performed. The duration of the sling or brace will be discussed with you.
Ice
Ice packs in the form of frozen peas or commercially available products are very good at
decreasing the inflammatory response. It is important not to place them directly against the
skin. You should have at least a tea towel between you and the ice to minimize any chance of
a cold burn. They are applied for 20 – 30 minutes or until they thaw out and up to every two
hours.
Cryocuff® is a commercially available cooling and compression system available through
Club Warehouse, Level 1,221 Kerr St, Fitzroy 9419 7344 clubwarehouse.com.au. Other
brands are also on the market.
Gentle Movement
The inflammatory response results in you keeping the affected joint still, and prolonged
immobility often results in stiffness that can be difficult to treat later. Prevention is the best
form of treatment, and with periodic controlled gentle movement in combination with
analgesia and ice, stiffness can be avoided.
Wound Management
Most wounds are managed with an absorbable (dissolving) suture that will not need
removing. They are usually supported with steristrips for a period of 10 to 14 days. A
dressing, often a Primapore, is placed over the top. Ideally the dressings will remain intact
until review. I am happy for them to be wet in the shower and dabbed dry afterwards.
Immersion in baths, swimming pools and the beach should be avoided.
If wound appearance is a significant concern, application of 3M micropore 1-inch tape along
the wound for over three months can result in a finer, less obvious surgical scar. All surgical
scars progress through a number of phases included a red phase that lasts up to 18 months.
If there is discharge associated with redness around the wound, this may represent infection.
You should be seen earlier and have the wound reviewed.
Smoking
Smokers are disproportionately represented in all forms of surgical complications. From
increased local problems such as delayed wound healing, wound infection, tendon/ligament
repair failure, stiffness and bone delayed healing to the general complications such as
thromboembolism (Deep Venous Thrombosis and Pulmonary Embolism), pneumonia and
heart complications.
Physiotherapy
In the early phase of your recovery, physiotherapy will be used sparingly. Most of your early
rehab is known has a “home exercise program”. The exercises that you have been shown will
help avoid stiffness. When you are out of your brace, using your limb for activities of daily
living, more movement will return. Once movement is regained, strength will follow. At
your periodic postoperative review appointments your progress is assessed and if I have any
concerns, physiotherapist supervision will be advised. In general terms, most patients will be
formally referred to physiotherapists at the three-month review for further direction and goal
setting.
The tendon / ligament healing process is weakest at 4 months. I would like to avoid the
possibility of you being able to generate near maximal power and potentially pull the repair
apart at this time. Testing a repair to failure point is irreversible.
Post Operative Appointment
Your first post operative appointment will be scheduled for 10 to 14 days after your
operation. At this appointment, your wound shall be inspected, an explanation of your
operation provided, the rehabilitation plan discussed and you shall have an opportunity to
ask further questions.
Any concerns, please contact my rooms on 9486 9554.
Simon Holland

Source: http://www.robertbrennanmd.com/pdf/post-operative-care.pdf