 |
Pain
Management
In
the PACU/Recovery Room you will be asked to rate your pain
This helps us
to objectively evaluate how much discomfort you are having.
The scale that we most often use is the 0 -10 scale. 0 is no
pain and 10 is the worst possible pain.
| 0 |
1
2 3 |
4
5 6 7 |
8
9 10 |
| no
pain |
minimal
pain |
moderate
pain |
worst
possible pain |
At
Home
It is best to have someone
stay with you after you arrive home from your surgery. If this is
not possible, we recommend that you arrange to have someone available
by phone.
|
Some patients have concerns about taking care of themselves
when they go home. Please discuss these or any concerns you
may have with your nurse during your preoperative interview.
|
|
A nurse from the recovery room will try to call you the day
after your procedure to see how you are doing and answer any
of your questions. |
|
If
you need to speak to a nurse, you may call the Surgery Center
at (415)346-1218. A nurse is available Monday through
Friday. |
|
Your
surgeon is available to you as well. You can reach him/her
at their office or they can be paged through their answering
service. |
It is important
that you fill the prescription for your pain medication.
|
Patients are often comfortable when leaving the surgery center
and do not think they will need anything as strong as a prescription
pain pill. |
|
Many surgeons use local anesthesia at the wound site so that
you will be fairly comfortable until the local anesthesia
wears off, which sometimes does not occur until later in
the day or even into the next day. |
|
It
is much easier to keep your pain under control than try to
alleviate it with more medication once you are very uncomfortable.
We recommend that you fill your prescription as soon as possible.
|
|
It is often helpful to fill your prescription before your
day of surgery. Please bring your insurance card with you.
|
Take
pain relief drugs when pain first begins
|
It is much easier to control your pain when you take your
pain medication as prescribed. |
|
Most patients on the day of surgery, that evening and the
following day will need to take their pain medication every
4 to 6 hours. |
- As
your discomfort lessens you may change taking your prescription
narcotic medication to a Tylenol or ibuprofen like drug
as ordered in your discharge instructions
|
- As
long as you are taking narcotic type medication you should
not drive, drink alcohol or do anything that requires coordination
or judgement activity
|
|
|
If
the pain medication prescribed for you is not effective in
alleviating the discomfort, you should contact your surgeon.
|
|
Please
follow the advice of your surgeon if ice and/or elevation
to the surgical area is recommended. |
Some
pain medications can cause constipation
|
If this happens, you may take a stool softener (such as Colace),
or a gentle laxative (such as Milk of Magnesia). |
|
You do not need a prescription for these medicines. |
Do not drive while you are taking "narcotic"
pain medication.
|
This includes medicine like Percocet, Tylenol #3, and Vicodan.
|
Prescription
Pain Medications and Non-Narcotic Pain Medications
Below we
have provided general information about some of the commonly prescribed
pain medications. The information provided here does not contain a
full description of the medication listed. For specific medication
information, such as dosage, adverse effects, side effects and possible
contraindications, please consult your pharmacist.
All of these medications are best taken with food in your stomach
such as a few crackers or toast.
Non-Narcotic
Pain Medications
Tylenol/Acetaminophen
|
Benefits: |
- These
medicines reduce swelling, fever, inflammation and mild
to moderate pain after surgery.
|
- They
can lessen or eliminate the need for stronger medications.
|
- NSAIDS
can be used alone or in combination with narcotic pain medication
to help control more severe pain.
|
| |
|
Risks: |
- NSAIDS
can interfere with blood clotting.
|
- They
may cause nausea, vomiting, stomach pain and heartburn.
|
- Check
with your doctor or your discharge instructions before taking
this medication.
|
Narcotic
Pain Medication
(A
prescription is necessary for these medications. These medications
may not be refilled.)
|
Tylenol #3 (Tylenol with Codeine) |
|
Vicodin (Hydrocodone) |
|
Percocet/Roxicet |
|
Demerol
|
|
Benefits: |
- Most
often used for acute pain such as short-term pain after
surgery.
|
- They
do not cause bleeding.
|
- It
is rare for patients to become addicted as a result of taking
narcotics for post-operative pain.
|
|
Risks: |
-
Narcotics may cause drowsiness, nausea, constipation, itching,
or interfere with urination.
|
-
Some of these medications contain acetaminophen (Tylenol).
If you have liver disease, consult your doctor before taking
this medication.
|
-
Do not take more medication than prescribed by your doctor.
|
-
Do not drink alcoholic beverages while taking these medications.
|
-
If you are taking the medication as directed and you do
not have pain relief, please call your doctor.
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Operating
Room
| Who
will be in the operating room with me? |
|
Your
peri-operative team consists of your surgeon and their assistants,
nurses, anesthesiologists and a surgical technician.
|
| Where
do I go to sleep? |
|
You
will be prepared for your surgery in the pre-operative holding
area where you may receive some sedation to reduce your anxiety
and make you sleepy. Your anesthesia will be administered
in the operating room. |
| How
do I get to the Operating Room? |
|
You
will be transported on a stretcher accompanied by your anesthesiologist
and nurse. Once in the room you will be assisted in transferring
to the operating room bed. |
| How
will I be positioned in the operating room? |
|
The
operating room team will assist you to a comfortable position
on the operating room bed. If you have back problems or difficulty
lying flat, please let the nursing staff know so we can take
extra care in positioning you for your surgery. |
| Why
is the operating room so cold? |
|
The
operating room temperature is kept low for several reasons:
the maintenance of our equipment, the sterility of our supplies,
for the comfort of your surgical team who are required to
wear long sterile gowns and work under hot lights. We provide
you with warm blankets as soon as you are settled in the operating
room. |
| Will
I be able to see my surgery being performed? |
|
We
find it best for our patients not to see the actual procedure.
If you chose a type of anesthesia where you are awake, the
operating room team will keep you informed of the progress
of your surgery. |
| Why
is there so much equipment in the room? |
|
Our ambulatory operating rooms are fully equipped for all
types of surgical procedures. This means that much of the
equipment and supplies you see may not be necessary for your
procedure. |
| Are
family members allowed into the operating room? |
|
Family
members are not allowed into the operating room for safety
and sterility reasons. If your family member does not speak
English or has communication difficulties, an interpreter
will be provided who has been trained to assist the operating
room staff. |
Recovery Room
The
PACU, post anesthesia care unit or recovery room, is the name
of the room where you will recover from your surgery and anesthesia.
An experienced post anesthesia care nurse and anesthesiologist
will be there to care for you during this time. |
|
Frequently Asked Questions About the Post Anesthesia Care Unit
What happens in the PACU/Recovery?
|
During your recovery you will be placed on a heart monitor that
continuously monitors your pulse and blood pressure. |
|
A finger cover is placed on your finger. It tells us how much
oxygen is in your blood and how well you are breathing. |
|
Your
temperature will be taken by placement of a small probe in the
outer ear canal. It is a quick way to check your temperature.
You will feel a slight pressure in your ear when this is done. |
|
When you first wake up you may have an oxygen mask covering
your mouth and nose. It is important to keep it on until your
nurse removes it. |
|
If you have an incision or bandage, your nurse will be checking
the area for any bleeding. |
|
When you are awake and ready for fluids, you will start drinking
small sips of water. |
How
will I feel after surgery?
|
You may feel sleepy, dizzy and/or forgetful from the medications
given to you during your operation. These feelings will improve
as time passes. |
|
You may have some discomfort after your surgery. The nurses
will give you medication to make you feel better. |
|
If
you have had a spinal anesthetic or a nerve block to an extremity,
the extremity will feel numb and heavy and you may not be able
to move it. This is not cause for worry. The normal feeling
and movement will return with time as the medication wears off. |
How
long will I be in the PACU?
|
The average recovery time is usually between 30 to 90 minutes.
Since each person is unique recovery time will vary. |
|
|
You can be discharged home when you are reasonably comfortable,
awake and alert, pain is manageable and you have minimal nausea. |
Will
someone explain to me what I should do when I get home?
|
Before you are discharged home, the nurse caring for you will
review your discharge instructions with you and your family. |
|
All of your questions will be answered before you go home. |
|
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Our phone number will be given to you to call if you have questions. |
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Always feel free to call your surgeon for any questions or problems. |
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If you do not know your surgeon's phone number, please call
the Surgery Center @ (415) 346-1218. |
Wound
Care
You
will receive specific instructions about how to care for your wound
from your surgeon. These instructions will be found on your discharge
instruction sheet given to you on the day of surgery. This page has
additional information that you may find helpful for taking care of
your wound.
|
You should check the dressing for any drainage. A small amount
of clear or light red staining is normal. |
- If
the dressing becomes soaked with bright red blood you should
call your surgeon.
|
|
Mild swelling along the incision is normal. |
- If
you should experience any increase in swelling, pain and/or
firmness around the surgical area, call your surgeon.
|
|
It is normal to feel a ridge along the incision; this will go
away. |
|
You
may remove your dressing when directed by your surgeon. |
| |
- Most
patients will remove their dressing within one to three
days of surgery. You will find information about your dressing
in your discharge instruction sheet
|
To
Remove The Dressing:
**
Always wash your hands first with soap and water**
|
Remove
the outer dressing. |
|
DO NOT REMOVE the steri-strips (the thin paper strips that
are on your incision) they will fall off on their own. |
|
Some
patients find it easier to remove the dressing in the shower
where the tape comes off more easily. |
|
The dressing should remain dry until you are allowed to shower.
Baths should not be taken until your surgeon has said that you
may do so. The wound should be gently washed with plain soap
and water. Pat the incision dry. |
For Best Wound
Healing
|
Maintain good nutrition; eat a well balanced diet. |
|
Do not smoke . |
|
Watch
the incision for signs and symptoms of infection . |
|
Keep your incision dry. |
|
Do not use deodorants, powders, lotions or sprays on/or near
the incision. |
|
Do not use any ointments on your incision unless you were told
otherwise. |
|
Do
not expose incision to sun. Once incision is fully healed use
sunscreen over the incision. |
|
Follow your doctor's instructions. |
Signs
and Symptoms of wound infection
**If
you have any of these signs or symptoms call your surgeon**
|
Redness
around the incision that is spreading. (It is normal
for the area around your incision to be slightly red). |
|
Increased
warmth and swelling around the incision . |
|
Increased
tenderness and pain. |
|
Foul smelling drainage. |
|
Temperature
of 101 degrees or higher and/or chills. |
Other
Resources
For your convenience
we have put together a list of web sites which may be relevant to
your ambulatory surgical experience. This list is not exhaustive
but rather represents a small selection of the many related web
sites available.
HealthSouth
Corporation
See
Resource Center
http://www.healthsouth.com
Agency
for Healthcare Research and Quality
ConsumerHealth
http://www.ahcpr.gov/consumer
American
Society of Anesthesiologists
http://www.asahq.org
American
Society of PeriAnesthesia Nurses (ASPAN)
http://www.htmlan.org
Association
of Operating Room Nurses (AORN)
http://www.aorn.org
Healthfinder
Consumer Health and Human Services government website
http://www.healthfinder.gov
Oncolink
University of Pennsylvania Cancer Center
http://cancer.med.upenn.edu
Pain
Control after Surgery A Patient's Guide
Agency of HealthCare Policy and Research: Consumer Health
http://text.nlm.nih.gov
When
You Need an Operation
American College of Surgeons
http://www.facs.org/public_info/operation/wnao.html
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Food and Drug Interactions
| The
following text has been prepared for you by Food and Nutrition
Services and Pharmacy Services. It contains information about
some common interactions that may occur between the food and
drugs that you take. It does not attempt to discuss all possible
food and drug interactions, nor does it list all possible
food and drug interactions. For information regarding food
and drug interactions, consult your pharmacist or doctor.
Analgesics
Aspirin and Nonsteroidal Anti-inflammatory Drugs (NSAlDs)
Aspirin, other salicylates (TriJisate, Disalcid, Dolobid)
Ibuprofen (Advil, Morrin, Nuprin and various other brands)
Ketoprofen (Orudis KT)
Naproxen (Aleve, Naprosyn, Anaprox)
Other NSAlDs (Indocin, Clinoril, Daypro, Feldene,
Lodine, Relafen, Toradol, Voltaren, etc.)
These agents may cause stomach upset and should be taken with
milk or food. Do not take these drugs with anticoagulants
such as Coumadin without discussing risks with your doctor
or pharmacist. Gastrointestinal bleeds may result with improper
or excess use.
Narcotic
Analgesics
Morphine
Codeine
Meperidine (Demerol)
Percocet
Percodan
Vicodin, other narcotics
These drugs may cause drowsiness, constipation and stomach
upset. Take with milk or food. Avoid alcoholic beverages.
Phenazopyridine (Pytidium)
Take 1/2 hour before meals with a full glass of water. This
drug may change the color of your urine.
Antibiotics
Cephalosporins (Cedor, Ceftin, Keflex, VeloseD
For best results, take on an empty stomach (l hour before
meals or 2 hours after meals). If stomach irritation occurs,
take with milk or a light snack (i.e. crackers).
Erythromycins (E-mycin, Erytab, EryC, Biaxin, Zithromax)
Take on an empty stomach or immediately before meals. Avoid
taking with citrus foods, citrus juices and carbonated beverages.
Metronidazole (Flagyl)
This drug may cause stomach upset. Take with food. Avoid alcoholic
beverages while taking, otherwise nausea and vomiting may
occur.
Nitrofurantoin (Macrodantin)
This drug may cause stomach upset and change the color of
urine. For best results, take with milk or food.
Penicillins (PenG, Pentids, Ampicillin)
Take on an empty stomach (l hour before meals or 2 hours after
meals). Take with a full glass of water. Avoid taking with
citrus foods, citrus juices and carbonated beverages.
Amoxicillin
Pen VK
Augmentin
Absorption is unaffected by food.
Quinolones (Cipro, Floxin, Noroxin)
Avoid antacids 2 hours before and up to 3 hours after taking
medication. Take with a full glass of water.
Tetracycline (Sumycin)
Avoid iron and calcium supplements, antacids, milk and milk
products. For best results, take on an empty stomach (1 hour
before meals or 2 hours after meals).
Anticoagulants
Warfarin (Coumadin, Dicoumarol)
Avoid alcoholic beverages. Maintain a consistent diet of foods
containing vitamin K (see foods high in vitamin K chan). Check
with your doctor before taking aspirin, aspirin-like products
and nonsteroidal anti-inflammatory agents (NSAIDs) such as
Advil, Motrin and Aleve.
Gastrointestinal
Preparations
Diphenoxylate (Lomotil)
Avoid alcohol or other depressants such as tranquilizers or
sedatives.
Metoclopramide (Reglan)
Take 1/2 hour before meals. This drug may cause drowsiness.
Avoid alcoholic beverages.
Cimetidine (Tagamet)
Take before meals. Stagger doses of antacids.
Famotidine (Pepcid)
Nizatidine (Axid)
Ranitidine (Zantac)
Absorption is unaffected by food.
Omeprazole (Prilosec)
Lansoprazole (Previcid)
Take before any meal.
Laxatives (Colace, Metamucil)
Take with 8 ounces of water.
Miscellaneous
Antihistamines (Benadryl)
This drug may cause stomach upset and frequently causes drowsiness.
Take with food. Avoid alcoholic beverages.
Corticosteroids
Prednisone (Deltasone)
Prednisolone (Delta-Cortef)
Hydrocortisone (Cortef)
May cause stomach upset. Take with milk or food.
Food
Information List
This list is not entirely inclusive. For more information
please consult your dietician or doctor
Foods high in vitamin K
Asparagus
Broccoli
Brussel sprouts
Cabbage
Cauliflower
Dark lettuce
Varieties
Garbanzo beans
Green beans
Green peas
Green tea
Liver
Soybean oil
Spinach
Turnip greens
Vegetable Oils
Food high in potassium
Fruits
Apricots (dried)
Banana
Cantaloupe
Dates
Dried fruit
Figs
Honeydew
Kiwi
Nectarine
Oranges (juice)
Papaya
Pomegranate
Prunes (juice)
Pumpkin
Raisins
Rhubarb
Vegetables
Artichokes
Asparagus
Avocado
Bamboo shoots
Beans, dried
Broccoli
Brussel sprouts
Carrots
Celery
Parsnips
Peas
Potatoes
Spinach
Squash
Sweet potatoes
Tomatoes (juice)
Other
Bran cereal
Chocolate
Milk
Molasses
Salt substitute
Swiss chard
Drug affect by grapefruit juice
Recent studies have shown that grapefruit juice may interact
with the metabolism of some drugs. For further information
please consult with your doctor.
Consider avoiding grapefruit juice with the following medications:
Felodipine
Nifedipine
Nimodipine
Nisoldipine
Verapamil
Caffeine
Cyclosporine
Erythromycin
Estrogens
Midazolam
Terfenadine .
|
What
you should know about herbal use and anesthesia
| Name
of Herb |
Common
Uses |
Possible
Side Effects or Drug Interactions |
| Echinacea |
Boosts
the immune system and helps fight colds and flu; aids wound
healing |
May cause
inflammation of the liver if used with certain other medications
such as anabolic steroids, methotrexate or others |
Ephedra
(also called Ma-Huang) |
Used in
many over-the-counter diet aids as an appetite suppressant;
also for asthma or bronchitis |
May interact
with certain antidepressant medications or certain high-blood
pressure medicines to cause dangerous elevations in blood pressure
or heart rate. Could cause death in certain individuals. |
| Feverfew |
Used to
ward off migraine headaches and for arthritis, rheumatic disease
and allergies |
May increase
bleeding, especially in patients already taking certain anticlotting
medications. |
| Garlic |
For lowering
cholesterol, triglyceride levels and blood pressure |
May increase
bleeding, especially in patients already taking certain anticlotting
medications. |
| Ginger |
For reducing
nausea, vomiting and vertigo |
May increase
bleeding, especially in patients already taking certain anticlotting
medications. |
Ginkgo
(also called ginkgo biloba) |
For increasing
blood circulation and oxygenation and for improving memory and
mental alertness |
May increase
bleeding, especially in patients already taking certain anticlotting
medications. |
| Ginseng |
Increases
physical stamina and mental concentration |
May cause
decreased effectiveness of certain anticlotting medications.
May see increased heart rate or high blood pressure. May cause
bleeding in women in women after menopause. |
| Goldenseal |
Used as
mild laxative and also reduces inflammation |
May worsen
swelling and/or high blood pressure. |
| Kava-kava |
For nervousness,
anxiety or restlessness; also a muscle relaxant. |
May increase
the effects of certain antiseizure medications and /or prolong
the effects of certain anesthetics. Can enhance the effects
of alcohol. May increase the risk of suicide for people with
certain types of depressions. |
| Licorice |
For treating
stomach ulcers. |
Certain
licorice compounds may cause high blood pressure, swelling or
electrolyte imbalances. |
| Saw
Palmetto |
For enlarged
prostate and urinary inflammations. |
May see
effects with other hormone therapies. |
| St.
John’s Wort |
For mild
to moderate depression or anxiety and sleep disorders. |
May prolong
the effects of certain anesthetic agents. |
| Valerian |
Mild sedative
or sleep-aid; also a muscle relaxant. |
May increase
the effects of certain antiseizure medications or prolong the
effects of certain anesthetic agents. |
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