Learn More About What Happens After Your Surgery
Once your procedure has been finished, it is important to continue to take special care of yourself and follow a few guidelines to ensure your recovery gets off to a good start. This can minimize your recovery time and help you get back on your feet sooner.
The Recovery Room
Once the surgery is finished, your recovery starts in the Post-Anesthesia Care Unit (PACU). Although it may have taken mere moments for the general anesthesia to take its full effect, waking up from it can take far longer.
Your anesthesiologist maintained your state of deep sleep throughout your surgery procedure, and during this time, muscles and fat absorbed some of the anesthetic, which helped to maintain its levels in the brain and blood. It takes time for it to be flushed from these tissues, and you will likely still feel the effects of the anesthetic for some time after your procedure is complete. The amount of time you may spend in the PACU depends on several factors, including the pre-operative medication, the type of anesthetic, and the length of time an anesthetic was administered during surgery.
When you start to recover from your slumber, your hearing is the first sense to return following general anesthesia. The PACU staff will be there, speaking in a reassuring tone while letting you know what they are doing.
Assessing Your Needs and Vital Signs
In the PACU, you may be fitted with certain devices to automatically monitor their vital signs, such as a blood pressure cuff, oximeter, and EKG leads. You will also be fitted with an IV for a consistent feed of hydration and medication directly into your veins and a urinary catheter to help the nurse monitor your kidney functions and hydration levels.
It is not uncommon to feel cold after surgery, so the nurse will also be sure to give you plenty of warm blankets.
Nurses will closely monitor your breathing while you are in the PACU. Deep breathing and filling your body with oxygen helps your body eliminate the remaining anesthetic that may still be lingering in your body tissues. Your nurse may even ask you to breathe into a spirometer, which is a small device used to measure lung capacity. This can help you see just how deeply you are breathing and motivate you to breathe deeper.
Because lying flat for long periods of time can cause fluid to accumulate in your lungs, your nurse will position you upright and ask you to cough while breathing deeply. This can loosen and remove some of that fluid that develops in your lungs, and in turn can prevent you from catching pneumonia.
- If you experience any of the following symptoms, you should contact our clinic immediately, as they should be treated right away:
- Fever greater than 100.5° F after 3 days from surgery, including chills and/or night sweats
- Redness, fluctuance, warmth, swelling, and/or foul-smelling drainage from your surgical site
- Failed sutures or staple sites
- Blood, yellow, or greenish discharge from your surgical site
- Chest pain, shortness of breath, or pain in the neck or arm
- Increasing numbness or weakness, especially in the groin areas
- Changes in bowel or bladder function
- Burning or itching with urination
- New calf or leg pain
If you are exhibiting any of these symptoms or they are worsening and it is after our clinic hours, do not hesitate to go to the emergency room at the nearest hospital. The attending physician will be able to phone or page our on-call physician for further assistance. We are not able to examine you over the phone!
If you experience any skin irritations, such as itching or irritation from tape adhesives, you may use an antihistamine (like Benadryl). You may also lightly cleanse the affected area, but not the incisions, with mild soap to remove the irritant. Recommended cleansers are Exidine, Hibiclens, Phisoderm or an equivalent. These are relatively routine and do not need immediate medical attention from a professional.
If you are experiencing any swelling or pain, you may apply ice to the area, but do not use heat as it will worsen the condition.
You may start showering the day after your surgery. Allow water to run over the incision and wash the area with soapy water, rinse, and pat dry. However, there are a number of things you should avoid to allow your incision to heal optimally.
- Avoid the following hygiene procedures:
- Do NOT re-cover the incision with a dressing/gauze
- Do NOT attempt to remove any sutures, staples, or Steri-Strips that might be present, as these will be removed in our office at your first post-operative visit
- Do NOT apply any ointments, lotions, creams, or powders to your incision
- Do NOT use any baths, hot tubs, Jacuzzis, or swimming pools until your wound is completely healed and you have been cleared by your physician; wounds must be closed completely prior to being fully-submersed in water.
It is very important you have someone check your incisions daily for signs of infection, such as increasing redness, warmth, pain, yellow or green or foul-smelling drainage, or a fever greater than 100.5°.
When should my first post-operative visit be?
Your first office visit should be 10-14 days after your procedure. If you needed additional rehabilitation, your first office visit should be 14 days after your discharge. Your doctor will advise you of additional follow-up appointments at your visit.
How can I manage constipation after my surgery procedure?
Constipation after surgery is relatively common and it can be managed through several common over-the-counter medications. If left untreated, it will exacerbate spinal pain, however so prevention is critical. Start the following over the counter regimen as soon as you get home:
- Colace or Pericolace, 100mg tablet, twice a day ALONG WITH Milk of Magnesia, 30CC once a day
- Citrucel or Metamucil fiber supplements, twice a day
- A stimulant such as Senekot-S, Dulcolax suppository or Fleet enema if you have not had a bowel movement after several days
Continue this regimen for two weeks after your surgery, or as needed if your symptoms persist or stop before then. If you experience diarrhea, you may back off the remedies.
What activities are permitted or restricted when I first get home?
Fatigue is normal for the first 3 months after surgery, and you will need lots of rest to help your body recover.
- Keep the following activity restrictions in mind following your surgery procedure:
- Walk as much as you can. There are no limitations, but you should listen to your body and rest when you are tired. It’s not good to over-exert yourself while in recovery. You may discontinue using the TED hose/stockings one week after surgery, but only if you are walking frequently throughout the day.
- Limit your exercise to walking (using a treadmill is fine) and/or a stationary bike.
- Limit sitting to 30 minutes at a time, no more than 4 times a day. Sitting for long periods will tend to make your back sore.
- Because falling or other sudden trauma can disrupt any surgical work done on your spine, take extra precautions when using stairs, walking on uneven surfaces, snow, ice or anything that could cause you to fall, especially within the first 6 months of surgery.
- Limit lifting to a maximum of 3 pounds in the first week following surgery, 5 pounds in the second week, 10 pounds in the third week, and 20 pounds at four to six weeks.
- Use a lumbar-supportive corset/brace immediately following your procedure. When you feel you are ready, you may begin to wean yourself from it, or any walkers or canes.
- Do not lift, stoop, bend or twist more than 20% of your normal range of motion.
- Drive when you feel ready but never do so while you are under the influence of your medications.
- Use a position of comfort and control when you feel you are ready to begin sexual activity.
- Use common sense with all of your activities. If it will place a lot of stress on your spine, avoid that activity.
What should I know about my medications before and after surgery?
Narcotics, controlled substances, muscle relaxers, and sedatives are potent pain medications used to control acute surgical pain and other pain syndromes. They have a high potential for psychological or physical dependence.
Stopping pain medication abruptly may lead to withdrawal symptoms. You may experience insomnia, irritability, agitation, headache, tremors, sweating, racing heart, runny nose or eyes, diarrhea, hot flashes, poor appetite and increased pain as a result of suddenly stopping these medications, so we always advise gradually reducing your dosages when coming off of them. These symptoms usually last 3-7 days depending on the medication and dosage.
Due to their addictive or dependent nature, various pain medicines can only be picked up in person at the pharmacy, and prescriptions for these medicines cannot be called-in or faxed. We expect you to adhere to the clinic prescription medication refill policies and agreements. Do not take medications or substances that have not been authorized by a physician. This includes over the counter remedies, herbal supplements, etc.
Because they can cause sedation or cognitive/motor impairment, you should never drive, operate heavy machinery or dangerous equipment, or perform executive or critical decisions while under the influence of these medications. Only resume these activities if you can function without any physical impairment or unsafe side effects, or if you have stopped taking the medications.
If these medications are required longer than necessary for chronic pain well after surgery, you will be referred to either your primary care physician or to a pain specialist to continue pain management. We do not manage chronic or long-term pain.
A note for spine fusion patients: Avoid Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), steroids and cytoxic drugs (rheumatoid/anti-cancer agents) for the first 3-6 months since these may inhibit bone growth. The medical literature is controversial and another medical professional may advise one of these treatments, but we prefer to be conservative.