Your Hand/Elbow Surgery at HSS: What to Expect
Jaime Ortiz, MD
2006-2007 Regional Anesthesia Fellow
Hospital for Special Surgery
The Weeks and Days Before Your Surgery
When scheduling your procedure with your surgeon, make sure you obtain an estimate of how long you will be in the hospital. Most likely, you will go home the same day; alternatively, you might be required to stay in the hospital for a few days. Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans.
- Clearance: If your hand/elbow surgery requires you to stay overnight in the hospital, you will be referred by your surgeon to an internist for clearance for surgery. If you have a history of medical problems - even if you are scheduled to go home the same day as the surgery – your surgeon will often advise you to obtain pre-operative medical clearance. This clearance includes a history and physical exam as well as some laboratory tests. If your particular medical condition requires it, additional tests such as an EKG, chest x-ray, or cardiac stress test will be ordered at this time.
- Medications: You may be instructed by your surgeon and/or primary doctor to stop certain medications (such as strong blood thinners like Plavix or Coumadin) several days to a week before your surgery, depending on the medication. In addition, you may be instructed to take some of your medications the morning of surgery even though you won’t be able to eat that morning. It is important to bring a list (or a bag of pill bottles) including all your medications to your medical clearance, including vitamins, over-the-counter medications, and supplements (a number of medications and supplements may interact with medications you might receive after surgery.)
On the day before surgery, a nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, what medications to take, and by what time you should no longer have anything to eat or drink. This does not apply to medications that you have been instructed to take the morning of surgery with a small sip of water. Be sure to follow the nurse’s recommendations strictly, as your surgery might otherwise have to be re-scheduled.
The Morning of Surgery
On the morning of surgery, you will arrive several hours before your procedure is scheduled to begin.
- The “Holding Area”: You will come to the preoperative “Holding Area”, where dedicated staff will help prepare you for surgery. A locker will be provided for your belongings, but please leave any valuables at home. This includes all jewelry, as you will be asked to remove it before entering the operating room. You will be asked to change into a hospital gown and will be assigned a bed in the Holding Area. A nurse will start an intravenous line to give you fluids, and if you are a woman of child-bearing age, you will be asked to provide a urine specimen for a pregnancy test.
- Preoperative Exam: A physician’s assistant will take your history and perform a physical examination. The main purpose of this examination is to see if anything has changed since you last saw your medical or surgical physicians. You will be asked to confirm what type of surgery you are having and will be asked to sign consent for that surgery if you have not already done so. Your surgeon or one of his or her assisting physicians will come to speak to you and to sign your surgical site. This is simply a safeguard to confirm where on your body the surgery will be performed. At this time, you will also meet your anesthesiologist, who will discuss what type of anesthesia you will receive.
Anesthesia
Your anesthesiologist will review your medical history and chart while confirming the correct site of your surgery. He or she will then present you with the anesthetic plan and answer all of your questions. You will also sign your consent for anesthesia. Hand/elbow surgery at HSS is usually performed with an infraclavicular/coracoid block or an axillary block along with IV sedation. These regional nerve blocks allow for surgery to be performed on the specific extremity without the need for general anesthesia, and provide pain relief for several hours after the surgery.
The Operating and Recovery Rooms
- Anesthesia/Surgery: Once everything is ready, you will be taken to the operating room by a nurse. In the operating room, your anesthesiologist will measure your blood pressure and heart rate and provide extra oxygen via a tiny tube under your nose. He or she will then begin giving you sedative medication. One of the forms of anesthesia discussed above will be administered, and the surgery will begin. The level of sedation is variable, but most people remember waking up in the recovery room after the operation is completed. Occasionally, some patients recall some music or perhaps the sound of some tools being used. Be assured that you won’t feel any of the surgery. When the surgery is completed, your surgeon will speak with your family and you will be taken to the recovery room.
- Recovery Room: In the recovery room, you will fully awaken from the sedation. You will be placed back on the same monitors that were used in the operating room. Your recovery room nurse will decide when you can have something to eat and drink, and when you can see your family members. Depending on the complexity of the procedure, you may go home after your surgery, or your surgeon may admit you to the hospital. If you will be staying in the hospital for a few days, you will be assigned a room and will go there later that day or early the next morning. Most patients will be sent home on the same day after their hand/ elbow surgery. After postoperative instructions and prescriptions for pain are administered, you can go home. As your anesthesiologist will explain, you may continue to feel numbness and weakness of your arm and fingers that can last until the next day. When the numbness wears off, you will start taking the prescription given to you for pain as instructed.
Recovering in the Hospital
- Physical Therapy: The recovery process will be an active one. You will likely begin working with a physical therapist the day after your surgery. This is an important part of your recovery that will allow you to get back to your normal activities as soon as possible.
- Pain Management: An anesthesiologist and nurse from the Acute Pain Service will visit you each day to evaluate your pain. You will be provided with intravenous patient-controlled analgesia, or PCA. This is a button that you can push to administer a small dose of intravenous pain medication every ten minutes as needed. On the first day after surgery, you will be transitioned from the PCA to oral pain medications.
After one to four days of recovery, you will be discharged home, likely with a prescription for pain medication, a prescription for physical therapy, and a follow-up appointment with your surgeon.
