Preparing for your Surgery

General Preoperative Instructions

1 week before your surgery...

• Please stop taking medications that may increase your risk of bleeding or clotting complications. This may include aspirin or anti-inflammatory medications such as NSAID’s. This may include, but is not limited to Baby Aspirin, Advil, Motrin, Aleve, St. John’s Wort, Mobic. If you have questions about whether one of your medications falls into this category, please give us a call.
• Please purchase a bottle of Chlorhexidine soap (such as this one here* or this one*) and use it to wash the night before and the morning of surgery.
• If having shoulder surgery, please purchase a bottle or bar of peroxide and apply to the entire shoulder region, making sure to include the armpit as well, the morning of surgery.
• If you are currently taking any narcotic pain medication such as Percocet, Vicodin, Norco, Oxycodone, or any another narcotic medication, please stop taking them at this time or decrease their use as much as possible prior to surgery. Taking these medications prior to surgery can make it more difficult to manage any post-operative pain you may have.
• If you have any questions about your medications and how they may affect your surgery and your recovery, please do not hesitate to contact us in addition to your Primary Care Physician (PCP).
• If you have been requested to visit with your PCP prior to your surgery for pre-operative optimization/clearance, please have that visit completed before your pre-operative appointment.

Medications to Stop Before Surgery

14 days before surgery, you need to stop:

• Any Narcotic (example., Vicodin, Norco, Darvocet, Percocet or Oxycontin)
• Advil to aspirin like products to stop 14 days before surgery

7 – 10 days before, you need to stop:

Any prescribed medications (examples: Plavix, Coumadin, Warfarin, prescribed Aspirin), please consult with your prescribing physician/PCP if and when those medications need to be stopped prior to surgery

You can continue to take:

• Tylenol
• Celebrex
• Glucosamine Chondroitin Sulfate
• Daily Vitamins

If you are taking any other medications that are not listed, please consult with your PCP prior to surgery to determine if you should continue taking the medication or to see when you should stop and resume the medication.

Night before surgery

• DO NOT EAT or drink anything after midnight or your surgery could be canceled. You may have a sip of water with any medications you need to take. Take only the medications that your doctor (PCP) or the hospital nurse says it is okay to take
• Make a list of your current medications, past surgical procedures and medical problems to bring with you the morning of surgery. This information will be for the anesthesia team.
• Take a shower or bath the night before or morning of surgery using the Chlorhexidine soap. If having shoulder surgery, please also apply the peroxide soap or solution.
• Outpatient surgery: Make arrangements for someone to come with you to your surgery (see below). You will need someone to drive you home. The expected wait time will be about 6 hours from the time you arrive at the hospital until the time of discharge.

Before Your Surgery

What should I do to prepare for my surgery?

1. Do NOT eat or drink anything after mid night prior to your surgical date
2. Arrange for a family member or friend to accompany you to the hospital the day of your surgery.
3. Plan ahead for transportation home the day of your planned discharge.
4. Please make arrangements for your work/social schedule accordingly during your anticipated recovery time prior to your surgery.
5. While taking narcotic pain medication, you will not be permitted to drive. You may need to arrange for transportation to your initial follow-up visit if still taking pain medication at that time.
6. Unless told otherwise, you will need to have a follow-up visit 7-14 days after surgery, please make your appointment before your surgery.

What should I bring with me the day of surgery?

1. Photo ID
2. Insurance Card
3. Friend or family member who will be available the entire time and take you home after surgery
4. Wear comfortable, loose fitting clothing
   • Shoulder/elbow surgery: zip-up or button down shirt
   • Knee surgery: loose fitting pants or shorts

**Leave jewelry, money and valuables at home.

On the morning of surgery:

• Take only medications that are for your heart (hypertension, arrhythmias, etc.)
• If you use an inhaler, please bring it with you
• If you are taking diabetic medications, you should check with your internist to determine if you should take these medications on the morning of surgery

If you are taking any other medications that are not listed, please consult with your internist prior to surgery to determine if you should continue taking the medication or to see when you should stop and resume the medication.

Anesthesia

General

General anesthesia is used for many types of major surgery. It is given via a combination of medicines injected into the body through an IV or medicines inhaled through a tube or mask. In general anesthesia, a breathing tube is placed to protect the airway. It is normal to have a slight sore throat after your surgery with general anesthesia.

Nerve Block/Regional Anesthesia

A nerve block or regional anesthesia can be used alone or in combination with general anesthesia. It is used to block the nerve impulses from your extremities to the brain which decreases or blocks the pain sensations to the brain. It requires a needle being placed near and around nerves to administer a local anesthetic in a targeted region. This injection is commonly done under ultrasound guidance and is very safe. The anesthetic blocks pain impulses before they reach the brain. If used as the sole method of anesthesia, you may receive additional medication to provide sedation or allow you sleep through the procedure. The nerve block generally lasts 8-16 hours and sometimes longer. During this time, you may feel little to no pain at all while the nerve block is still in effect. During this time, it is recommended that you take your pain medication as prescribed and as scheduled to remain ahead of the pain before the nerve block wears off.

** Your anesthesiologist will speak with you directly prior to surgery to review your choice of anesthesia. If you have any questions about your post-operative medications and how you should take them, please do not hesitate to contact us. **

Dr. Thon and his team look forward to helping you get back to doing the things you love.