- After your surgery, you will be taken to the recovery area while your anesthesia wears off. Most patients receive oxygen at this time. As you wake up, you may be especially sensitive to lights, noise and temperature.
- The recovery area nurse will be checking your blood pressure, pulse and breathing frequently. This is routine and does not mean anything is wrong. You may experience some side effects from the anesthesia, such as nausea, shivering, sore throat or headache. Let the nurses know is you experience these or any other side effects and they will do what they can to assist you.
- Most patients receive a nerve block during surgery, which will numb the nerves that do down to the foot/ankle area. This block will last approximately 8-10 hours on average. However, some patients will still experience some discomfort after surgery. Your nurse is there to help assess your pain and give you the most effective medication that has been prescribed for you.
- When your nurse and anesthesiologist think you are ready, you will be discharged from the recovery area. If you are being admitted to the hospital after your surgery, you will be taken to your room at this time. You will receive your discharge instructions when you are ready to go home.
- If you are an outpatient and going home after your surgery, the nurse will help you to sit up and give you fluids to drink prior to discharge.
- Please understand that the post-operative course varies from patient to patient, and these are meant only as guidelines to a smooth recovery. These instructions may not cover all aspects of your post-operative care and recovery. Please feel free to call the office if you have further questions.
- If you have had toe surgery on the toes, it is important that you check the circulation to the toes more frequently. By pressing lightly on the toe, you will note that the color of the toe changes and gets a little pale (blanches). When you release the pressure on the toe returns to a more normal pink color (this is called capillary refill).
- **The toes must not be dusky, pale or blue. If you notice any adverse changes, contact the office immediately**
Wound Care and Bleeding
- Drainage and bleeding after surgery is normal. You may notice bleeding through the dressing or splint—this is quite common It is OK to place extra gauze over the dressing to reinforce it, but do not remove the entire dressing.
- **If the blood or drainage continues to drip and the dressing is saturated with wet blood after the first 24 hours, call the office**
- Do not remove your dressings, cast or splint unless you are specifically told to do so. Doing so could lead to skin problems, infection, and lack of healing.
- The type of dressing you will have post-operatively depends on the type of surgery performed. On the day of surgery, you will receive specific verbal and written instructions about your dressing. If you have a splint, you will not have to do anything. Occasionally, if you have a small dressing, you may be instructed on how to change it prior to you first post-operative appointment
- Regardless of the type of dressing, you should not get the incision wet for 10-14 days. This interferes with proper healing and may result in infection.
- BATHING INSTRUCTIONS: Do NOT get bandages wet. Cover your leg with a plastic wrap (usually 2 small / medium trash bags) with the open end taped water tight around your leg and a clean dry washcloth inside the bag covering the top of your bandage, and KEEP IT OUT OF THE TUB / SHOWER.
- When bathing, either take a sponge bath or hang the foot over the side of the bath. One safe technique is to get into the empty tub with your foot out of the tub, then fill the tub. It may help to sit on a stool in the tub / shower with the leg out.
Elevation and Ice
Swelling is to be expected after any surgery. It is difficult to specify what constitutes an abnormal amount of swelling. Unfortunately, a minor amount of swelling can remain for up to a year after your surgery.The more you elevate, the less pain you will have.
- When you return home, you should rest and keep the foot elevated.Elevation helps to minimize post-operative swelling and is recommended for 7-10 days after surgery. Often the easiest locations are to lie on the couch and place your foot on the top of the couch, or at the kitchen table with the foot on pillows resting on the table.
- Do not do any excessive or unnecessary walking during the first few days after surgery. Each operation is slightly different, and you may be told specifically not to put any weight on your foot at all. Under these circumstances, you will need to use either crutches or a walker. This does not mean you need to lie in bed all day, and should move every few hours if able, but restrict the time the foot is “down” to 10 minutes or less at a time.
- Use ice over the foot for 24 hours after surgery. If you do not elect to use a cold therapy unit, we recommend filling a large plastic bag with ice and propping the bag over the foot. Ice your foot for approximately 10-15 minutes every hour while you are awake. Do not ice your foot while you are asleep. Do not let the dressings get wet from the condensation on the ice bag. Placing a towel between the foot and the ice will help to prevent this. Do not place ice directly on your skin.
Unfortunately, everyone experiences some degree of pain after surgery. For some this is worse than others. You will be given a prescription for pain medication before you leave, but often this just “takes the edge off” during the immediate postoperative period. You will not be pain-free, and the first night will be painful and uncomfortable. This will improve with time. Please let the staff know if you are allergic to any medications. If you have had local anesthesia, it is important to start taking the pain medication when the anesthetic begins to wear off.
- RATING PAIN – Using a pain scale to describe your pain will help the staff understand your pain level so it can be managed effectively. “0” means you have no pain; “5” means moderate pain and “10” is the worst pain possible. While you WILL have pain after the operation, we strive to keep your pain at a “4” or below.
- NERVE BLOCK – This is an injection administered during your surgery, which will numb your foot/ankle after surgery. The duration of the block will be variable, but in most cases will last 8-10 hours. In some cases it might last longer.
- TAKING YOUR PAIN MEDICATION – It is advisable to begin taking your prescribed pain medication before your nerve block completely wears off.Our goal is to make you as comfortable as possible; however, you will still experience some pain. Pain medication should not be taken on an empty stomach.
- PAIN PROTOCOL –
- Tylenol 500mg by mouth every 6 hours x 5 days IF no liver disease
- Celebrex 200 mg by mouth twice a day x 14 days IF no cardiac history, no sulfa allergy, and no fusion procedure
- Oxycodone 5-10mg by mouth every 4 hours as needed for pain
- If bad reaction to Oxycodone, Dilaudid 2-4mg by mouth every 4 hours as needed for pain
- If prescribed, take Oxycontin ER 10mg by mouthtwice a day x 5 days
- WEANING OFF MEDICATION – After your pain begins to diminish, begin to taper your medication by taking fewer pills or taking them less often, as needed.
- Stop Oxycontin first, then Oxycodone, can then be prescribed Tramadol if still needed for pain
- MEDICATION REFILLS – It is important that you don’t wait too long to call for new prescriptions of narcoticpain medication. These prescriptions can no longer be called or faxed to your pharmacy, and we are not allowed to give refills. If you will need a refill in 3-4 days please call our office and speak to one of our staff that you had surgery with Dr. Switaj, your specific procedure you had done, and your surgery date. We will then coordinate to either mail you the prescription or you will need to have someone to pick up the prescription at our office.
- VENOUS THROMBOEMBOLIC (VTE) PROPHYLAXIS – There is a risk of developing a symptomatic blood clot following any lower leg surgical procedure. Although this risk is low, you will be prescribed a medication to help prevent the development of blood clots following your surgery. The type of medication, and duration of its use, will be a shared decision-making process between you and your physician.
- POST-OP NAUSEA – You will be prescribed a medication for the prevention of nausea during your post-op course (Zofran). This medication is to be used as needed.
- CONSTIPATION – A side effect of narcotic pain medications is constipation. Senokot-S (over-the-counter) is recommended, if taking narcotics. Drinking plenty of fluids and eating fresh fruits and vegetables will also help.
- Vitamin C 500mg PO once daily x 50 days. This is to help diminish the chance of developing a rare, but severe complication called Complex Regional Pain Syndrome (CRPS)