Post-Operative Instructions

Post-Operative Instructions Anterior Cervical Diskectomy & Fusion

Post-Op Pain

It is not unusual to experience the following symptoms in the first few weeks after surgery:

• Pain in and around the incision(s)
• Some persistent neck or arm pain, numbness and or tingling.
• Pain at the base of the neck, between the shoulder blades or across the shoulder area. This is very common.
• Mild swelling or redness at the incision(s)
• A sore throat that feels like something is caught when you swallow

Pain Medication

• You will be given prescriptions when you are discharged. Take them only as needed, following dosage directions. These are strong medications with addictive potential. You will not be given refills, except in unusual circumstances.
• Most patients require 3-4 days of narcotic pain relievers after surgery. Usually, the prescription of narcotic pain medication you are given at the hospital is enough medication for the entire recovery period.
• No prescription refills will be called in at night or on weekends.
• If your pain level does not require narcotic strength medication, you may begin over-the- counter Tylenol/acetaminophen once you are home. Please be advised that the Tylenol/ acetaminophen should be used with caution with the narcotic because the narcotic pain medication may also contain some Tylenol/acetaminophen.
• Do not use more than 3000 mg of Tylenol products in 24 hours, including amount contained in each narcotic tablet.
• We prefer you wait five days before starting other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Advil, Motrin, Ibuprofen, Nuprin, Aleve, etc., as these may cause some bleeding post op.
• It is ok to take the NSAID in addition to the narcotic pain medication. It may provide better pain relief if there are a couple of hours between the narcotic and NSAID. Read the package insert of the NSAID medication.

Incision Care

• Leave protective bandage in place for 48 hours post op, unless it gets wet or grossly soiled. After that, if there is no drainage, you may remove the dressing.
• You may have staples or steri-strips in place. Staples will generally be removed at your first office visit. Leave the steri-strips in place, unless they come off by themselves.
• You may shower immediately, as long as the dressing and incision remain dry/ waterproof. If the dressing gets wet or grossly soiled, or there seems to be any concern with the incision or adhesive, please change it.
• Do not tub bathe or soak the wound.
• If you choose to cover the incision, use a breathable, gauze bandage when the dressing is changed.
• Do not use oversized band-aid type dressings as these keep the wound too moist.
• Do not use ointments, creams, or solutions on the incision (i.e. No Neosporin, Vitamin E, hydrogen peroxide, etc.). Mild soap and water is OK.
• If you notice a small clear suture at the end of the incision, do not remove it. It will either dissolve or be removed in the office.
• If you develop blisters, redness, or irritation from the tape, discontinue its use.
• Persistent or purulent drainage should be reported to our office

Dos and Don'ts for Cervical Spine Surgery

• You should think of the first week after surgery as an extension of your hospital stay. In general, if any activity increases discomfort, don't do it. It will get easier each day. When you get home, call the office (703-560-1146) and make an appointment to see our nurse 7-10 days after surgery. You will see your surgeon approximately 3-4 weeks after surgery. An x-ray should be ordered after your first post-op visit.
• A neck collar will be given to you on discharge from the hospital. This is for your comfort only, as the collar may help with pain management and to help remind you not to move your neck in exaggerated movements. Wear it as needed.
• Do not use time at home as an excuse to do housework.
• Do not remain confined to bed during the day. Walk as much as you comfortably can. You may climb stairs. If you sit or stand for more than 20-30 minutes, you should get up and walk to avoid getting stiff.
• Avoid exaggerated bending or twisting or lifting more than 5-10 lbs.
• No exercise program until after your first office visit.
• Sexual activity is permitted whenever comfort permits.
• You may ride in a car as a passenger. Do not ride for more than an hour without getting out and walking for a few minutes.
• You may drive after 10-14 days post op, if you feel comfortable and are no longer taking the narcotic medications.
• Decisions regarding returning to work and physical therapy needs will be made on an individual basis by our medical staff.
• The pain medication can cause problems with constipation. Start a stool softener daily (i.e. Colace), increase fluids, and walk as tolerated to help with constipation. It is ok to use an over-the counter laxative or suppository (such as Milk of Magnesia or Dulcolax), as needed.
• It is ok to sleep on your side, back, or in a reclining position.
• Do not schedule dental work for 2 weeks prior to surgery or for 2 weeks following your surgery.

Calling the Office

We are here to help you. Please call with any questions. Our office will call you during the first week after discharge from the hospital to check on your progress. Notify the office if your phone number differs from the one you gave us at your initial visit. Call the office if any of the following occur:

• Sustained fever greater than 101.5 degrees Fahrenheit (by mouth) that does not respond to a dose of two tablets of Tylenol. Do not take Tylenol if any contraindications or allergies.
• Increased redness, persistent or increased drainage, or marked increased pain from the incision (spotty drainage may be normal for the first few days).
• Arm pain in excess of your pre-operative pain. Severe neck pain.
• Difficulty swallowing or breathing.
• Noticeable increased or continued swelling of the incision area.

Post-Operative Instructions Lumbar Spine Surgery

Post-Op Pain

It is not unusual to experience the following symptoms in the first few weeks after surgery:

• Pain in and around the incision
• Some persistent leg pain
• Numbness or tingling of the leg or foot
• Mild swelling or redness at the incision
• Muscle tightness or spasm of the back or leg
• Pain on moving from bed to chair or standing position
• It is not unusual to be uncomfortable during the first few days following surgery, and especially at night. This will improve steadily.

Pain Medication

• You will be given prescriptions when you are discharged. Take them only as needed, following dosage directions. These are strong medications with addictive potential. You will not be given refills, except in unusual circumstances.
• Most patients require 3-4 days of narcotic pain relievers after surgery. Usually, the prescription(s) of medication(s) you are given at the hospital is enough medication for the entire recovery period.
• No prescription refills will be called in at night or on weekends.
• If your pain level does not require narcotic strength medication, you may begin over- the-counter Tylenol/acetaminophen once you are home. Please be advised that Tylenol/ acetaminophen should be used with caution with the narcotic because the narcotic pain medication may also contain some Tylenol/acetaminophen.
• Do not use more than 3000 mg of Tylenol products in 24 hours, including amount contained in each narcotic tablet.
• We prefer you wait five days before starting other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Advil, Motrin, Ibuprofen, Nuprin, Aleve, etc., as these may cause some bleeding post op.
• It is ok to take the NSAID in addition to the narcotic pain medication. It may provide better pain relief if there is a couple of hours between the narcotic and NSAID. Read the package insert of the NSAID medication.

Incision Care

• Leave protective bandage in place for about 48 hours post op, unless it gets wet or grossly soiled.
• You may have staples or steri-strips in place. Staples will generally be removed at your first office visit. Leave the steri-strips in place, unless they come off by themselves.
• You may shower immediately, as long as the dressing and incision remain dry/ waterproof. If the dressing gets wet or grossly soiled, or there seems to be any concern with the incision or adhesive, please change it.
• Do not tub bathe or soak the wound.
• Use a breathable, gauze bandage when the dressing is changed. Do not use oversized band-aid type dressings as these keep the wound too moist.
• Do not use ointments, creams, or solutions on the incision (i.e. No Neosporin, Vitamin E, hydrogen peroxide, etc.). Mild soap and water is OK.
• If you notice a small clear suture at the end of the incision, do not remove it. It will either dissolve or be removed in the office.
• If you develop blisters, redness, or irritation from the tape, discontinue its use. Persistent or purulent drainage, or marked swelling, should be reported to our office.

Dos and Don'ts for Lumbar Spine Back Surgery

You should think of the first week after surgery as an extension of your hospital stay. In general, if any activity increases discomfort, don't do it. It will get easier each day. When you get home, call the office (703-560-1146) and make an appointment to see our nurse 7-10 days after surgery. You will see Dr. Hope approximately 3-4 weeks after surgery.

• Do not use time at home as an excuse to do housework.
• Do not remain confined to bed during the day. Walk as much as you comfortably can. You may climb stairs. If you sit or stand for more than 20-30 minutes, you should get up and walk to avoid getting stiff.
• Avoid exaggerated bending or twisting or lifting more than 5-10 lbs.
• No exercise program until after your first office visit.
• Sexual activity is permitted whenever comfort permits.
• You may ride in a car as a passenger. Do not ride for more than an hour without getting out and walking for a few minutes. You may drive after 5-7 days if you feel comfortable and are taking no narcotic pain medication.
• The pain medication can cause problems with constipation. Start a stool softener daily (i.e. Colace), increase fluids, and walk as tolerated to help with constipation. It is ok to use an over-the-counter laxative or suppository (such as Milk of Magnesia or Dulcolax), as needed.
• Decisions regarding returning to work and physical therapy needs will be made on an individual basis by our medical staff.
• Do not schedule dental work for 2 weeks prior to surgery or for 2 weeks following your surgery.

Calling the Office

We are here to help you. Our nurse will call you during the first week after discharge from the hospital to check on your progress. Notify the office if your phone number differs from the one you gave us at your initial visit. Call the office if any of the following occur:

• Sustained fever greater than 101.5 degrees Fahrenheit (by mouth) that does not respond to a dose of two tablets of Tylenol.
• Increased redness, persistent or increased drainage, or increased pain from the incision (spotty drainage may be normal for the first few days).
• Severe leg pain, or extended severe back pain.
• Leg swelling. This may signal a blood clot in the leg.

Post-Operative Instructions for Carpal Tunnel (Median Release)

Post-Op Pain

It is not unusual to experience the following symptoms in the first few weeks after surgery:

• Discomfort or pain around the incision and the palm of the hand toward the thumb
• Numbness or tingling of the hand or fingers
• Increased discomfort in the hand or incision with movement of the thumb

Pain Medication

• You will be given prescriptions when you are discharged. Take them only as needed, following dosage directions. These are strong medications with addictive potential. You will not be given refills, except in unusual circumstances.
• Most patients require 3-4 days of narcotic pain relievers after surgery. Usually, the prescription of medication you are given at the hospital is enough medication for the entire recovery period.
• No prescription refills will be called in at night or on weekends.
• You may begin over-the-counter medications such as Advil, Motrin, Ibuprofen, Aleve, or Tylenol/acetaminophen once you are home. Do not use more than 3000 mg of Tylenol products in 24 hours, including amount contained in each narcotic tablet.

Incision Care

There may be stitches or paper band aids (steri-strips) holding the incision closed.

• Avoid keeping your hand in a dependant position by elevating your arm and hand on a pillow for the first 24 hours.
• Keep the wrapped ace bandage on the incision for the first 48 hours.
• You may loosen or remove the outer wrap as needed in the first 48 hours if you notice increased swelling or color changes of your fingers. If you have persistent swelling or color changes in your fingers or hand, you should call the office.
• After 48 hours, you may remove the ace wrap to change the dressing over the incision. Place a 4x4 gauze over the incision and continue using the ace wrap to loosely protect the area until your first post op visit.
• Keep the dressing and incision clean and dry until the stitches are removed at approximately 14 days post op. You may place a plastic bag over the area to protect it while showering. We prefer no ointments or solutions on the incision.

Dos and Don'ts for Carpal Tunnel Surgery

• When you get home, call the office (703-560-1146) and make an appointment for approximately 14 days after your surgery to have your stitches removed by the nurse. It is important that your stitches stay in place at least 14 days. The office will help you with the correct timing of your post op appointment. You will see your surgeon approximately 4 weeks after the surgery.
• Do not lift anything greater than 10-15 lbs. in the first 6 weeks post op.
• Avoid exaggerated, repetitive bending of your wrist area in the first 1-2 weeks.
• You may drive at 1 week as tolerated. It is imperative that you not drive while taking prescription narcotic pain medication.
• You may return to work as tolerated at 5-10 days post op.

Calling the Office

We are here to help you. Our nurse will call you after discharge from the hospital to check on your progress. Notify the office if your phone number differs from the one you gave us at your initial visit. Call the office if any of the following occur:

• Increased, persistent swelling or color changes of the fingers or hand.
• Sustained fever greater than 101.5 degrees Fahrenheit (by mouth) that does not respond to a dose of two tablets of Tylenol. Do not take Tylenol if any contraindications or allergies.
• Persistent or purulent drainage from the incision (spotty drainage may be normal for the first few days).
• Increased redness or tenderness around the incision.