The purpose of this packet is to inform you about the surgical process. It will guide you through the steps of what will happen before your surgery, during your surgery, and after your surgery. Please read this packet carefully, with special attention to the details of how post-operative pain is managed. The more closely you read the packet, the easier and seamless this process will occur.
Before Your Surgery
At your office visit, you will discuss with Dr. Feldman the surgical procedure you are being recommended for. At this time, Dr. Feldman will discuss the risks of the procedure and you will decide if you agree to have the procedure performed.
Getting Scheduled
Once you have decided to have a procedure, the procedure must be scheduled. Brenda Scales, our surgical coordinator in the Germantown office, coordinates the surgical procedures. You can reach her at , extension 384. Dr. Feldman will give her all the information she needs to schedule the procedure. She will coordinate your schedule with Dr. Feldman’s schedule and find the most convenient time and place for you to have the procedure. Brenda can answer all of your questions regarding this process.
Pre-Operative Information
You may be also required to have certain evaluations done before your surgical procedure. The purpose of this is to make sure you are healthy enough to have surgery. Examples of these tests may include: a history and physical exam, lab tests, EKG, or other tests. Brenda Scales will provide you with information about the necessary testing for your surgical procedure. Please make sure you notify Dr. Feldman or the office staff if you have any health conditions including (but not limited to): high blood pressure, diabetes, heart conditions, kidney or liver disease, sickle cell disease, bleeding disorder, sleep apnea, or other medical conditions that may require further work-up before surgery. In addition, please provide the office staff with your most updated medication list.
IMPORTANT!!
Every procedure requires that you NOT eat or drink anything after midnight of the day of your procedure It is termed “NPO,” which literally means nothing by mouth. If you eat or drink after midnight, you will likely need to reschedule your procedure.
During Your Surgery
Anesthesia
Surgical procedures require some form of anesthesia.
General anesthesia: Most patients in outpatient practices are healthy enough to have general anesthesia. Under general anesthesia, you are asleep and you will not experience any pain during the procedure. This is the most common form of anesthesia used.
Most procedures will have an accompanied regional or local anesthetic. This is used to prevent or decrease post-operative pain.
Regional anesthesia: The operative site is completely numbed by a nerve block. This can be used for smaller procedures but is not practical for most, including most arthroscopic procedures.
Local anesthesia: The operative site is “numbed” with the use of a locally injected medicine. This can be used in very minor procedures.
Local anesthesia ONLY: some very small procedures can be performed with only local anesthetic. In this case, you will be awake during the surgery. The main advantage is that you can drive home if you are physically able to.
In the Operating Room
If you are getting general anesthesia, the anesthesiologist will inject medicine into your IV and you will fall asleep. You will be asleep during the entire procedure (if you have general anesthesia). After your surgery is completed, Dr. Feldman will place a dressing over your incisions and often a splint, brace, or cast over the area. When you wake up from anesthesia, you will be in the recovery room. You will remain in the recovery room until you are able to go home or are transferred to a hospital room, depending on the procedure that was performed.
After Your Surgery
Post-Operative Pain Protocol
One of the most important aspects of your early post-operative period is how your pain is managed. Your medications will either be prescribed for you at your pre-operative visit or on the day of surgery.
Pain Management Components
- The nerve block: if appropriate Dr. Feldman, or your anesthesiologist, will perform a nerve block to “prevent” pain during surgery. If the brain never feels pain during surgery, there will be less pain when the block wears off. Also, you will require substantially less anesthesia, reducing the side effects from those powerful medications.
- Injected local anesthesia: Medicine will be injected into your surgical site that will control pain at the site of injury. This blocks all the mechanisms of pain transmission at the site of surgery.
- Oral medications: This is the most critical part of the pain management because it is the one component that you are responsible for! These medications are taken on a schedule, much like an antibiotic. Following the schedule as closely as possible will significantly reduce your pain.
In the post-operative instructions you will find details of the medications you are prescribed. You are instructed to take the medications at the dose, frequency, and duration as described.
General information about the oral medications you may be prescribed:
- Anti-inflammatory (known as NSAIDs) – (ibuprofen (Advil, Motrin), celecoxib (Celebrex)): anti-inflammatory medications reduce pain. That is why Motrin is sold over the counter as a pain medicine. Celebrex is used for some upper extremity procedures and ibuprofen is used for all lower extremity procedures.
- Oral narcotics (oxycodone/acetaminophen (Percocet), hydrocodone/acetaminophen (Vicodin)): lastly, you will receive an oral narcotic. This medication is only used when all the above methods fail to make you pain free. This is the only medication that is NOT taken regularly. You only use it AS NEEDED.
Caring For Your Surgical Wound Dressing
You must keep the surgical site dry until otherwise noted by Dr. Feldman. In many cases, there can be localized drainage that becomes evident in your bandage. This should not be considered abnormal or a significant concern. If, however, you have significant soaking of the bandage with blood or if the bandage becomes wet accidentally, this may need to be changed. In that event, please make arrangements with the office at your convenience.
Summary
The goal is for you to be as educated at possible about the surgical process so that you have the best experience possible. The pain protocol works extremely well when followed.
If there is something you do not understand, please ask! If there is something that you think should be added to this packet, please let me know.
Pre-Operative Appointment
Once your surgery is scheduled, you will be contacted to schedule a telehealth appointment with Dr. Feldman's Physician Assistant, Jessica O'Keefe. This appointment will be scheduled approximately 1 week prior to your surgery. We encourage you to use this time to ask questions about your upcoming surgery, recovery, and post-operative instructions. Your post-operative pain medications will also be prescribed at this time.
