Scoliosis Fusion Preoperative, Postoperative and Home Recovery Instructions

Introduction

The purpose of this guide is to provide you and your family with information regarding your medical condition and planned surgery. This information is part of your medical “Informed Consent”. Please read it and follow the advice carefully. You should retain the guide for future reference and bring it with you to office appointments and to the hospital for reference.

After Your Operation

Pain

After surgery you will experience pain in the region of the incision. Persistent pain should be reported to your physician. Some patients experience a sore throat and swallowing difficulty after general anesthesia and surgery. This is from manipulation of tissue and the presence of the breathing tube for anesthesia. The sore throat usually will subside within a week. The swallowing difficulty usually takes longer. Using throat lozenges or lemon drops, sipping cool liquids, or sucking ice chips may soothe this pain.

Use of Pain Medication

Narcotic pain medication will be available for pain relief after surgery. Narcotics are very effective for pain relief but may cause other side effects. The possible effects vary among patients and may include: sleepiness, nausea, constipation, flushing, sweating, and occasionally euphoria or confused feelings are possible. If these occur notify your nurse. You may have a Patient Controlled Analgesia (PCA) pump. This is preferred by some but not all patients. When you depress a switch the pump will deliver narcotic pain medication directly into your IV without requiring repeated intramuscular injections. The PCA pump is closely monitored by the nursing and anesthesiology staff. If you feel you may benefit from this method of narcotic medication delivery, ask your nurse for a PCA pump trial.

Activity

Feel free to move about in your bed. IF YOU ARE GIVEN A BRACE, when the head of your bed is elevated above 60 degrees, or you are out of bed, your TLSO brace must be on. The nurse or therapist will assist you in getting out of bed a few hours after surgery. You will be instructed to be up walking every 2 to 3 hours during the day and evening. The nurse will allow you to do this independently once you are steady and feel comfortable. Early activity after surgery is extremely important to help prevent the complications of prolonged bed rest such as pneumonia and blood clots. It also promotes recovery, relieves muscle stiffness, allows for development of a well-organized scar, and improves your outlook. Elastic stockings (TED hose) were given to you immediately after surgery to prevent phlebitis (inflammation in your veins) in your legs. You may remove them after being discharged from the hospital. Do not start any programs of exercise or physical therapy unless discussed withyour doctor.

Diet

Your diet will begin with clear liquids, and be advanced to your normal daily diet as soon as your condition permits. Your IV will be removed as soon as we are reasonably certain it will no longer be required for medications and hydration.

Bowel and Bladder Function

During surgery you may have a catheter (tube) in your bladder to monitor your urine output. Upon its removal you may feel a stinging sensation for 2 to 3 days, which is normal. Some patients may have difficulty urinating after surgery. If this occurs, notify your nurse who may assist you in voiding techniques. This may require placing a catheter in your bladder. After surgery, constipation frequently occurs from inactivity and the side effects of pain medication. Stool softeners and laxatives will be available from your nurse.

Respiratory Hygiene

Deep breathing is very important after surgery to maintain lung expansion and reduce the risk of pneumonia. You will be provided with an incentive spirometer and instructed about its use. This device should be used every 15 to 30 minutes during your wakeful hours initially, then every 1 to 2 hours as your activity returns to normal. This device is yours to take home. Continue to use it at home for at least 1 week after your discharge. (Use it during TV commercial breaks). Smoking is absolutely forbidden. There is clear evidence that smoking dramatically increases your risk of post-operative complications. There is also evidence that smoking adversely effects bone healing and nerve recovery. Second hand smoke also applies. Home Recovery Follow-Up Appointment Patients are generally discharged from the hospital 2 to 4 days after surgery. A follow-up appointment should be made with Dr Ravi's office. At your follow-up visits, you will receive an x-ray of your low back the before your appointment.

Incision Care and Hygiene

After the 10th post-operative day, you are encouraged to shower daily. Do not soak your incision. Pat the incision dry. Do not apply any ointments or creams. Cover daily, for the first 5 days, with a clean dressing. A supply will be provided upon discharge. Surgical tapes or Steri-strips may be present to aid in holding the skin edges together. Allow these to fall off on their own. After five days post-operatively you no longer need to wear a bandage. NO BATHS, HOT TUBS, OR POOLS FOR 6 WEEKS AFTER SURGERY, it will increase your risk of infection.

Inflammation

Please take your temperature every afternoon for the first week after you are discharged from the hospital. Call your physician if:
  1. Your temperature, taken by thermometer, is more than 101.5 degrees, OR
  2. Your incision becomes reddened, swollen or any increase or change in drainage occurs.

Nutrition

A well-balanced diet is necessary for good healing and recovery. This includes food from the four basic food groups: dairy products, meat, vegetables and fruit. Use of narcotic pain medication and prolonged rest may cause constipation. Drinking plenty of fluids and eating high fiber foods (whole grains, raw fruits and vegetables) will help regain normal bowel function.

Home Pain and Medication

When we surgically relieve pressure from an inflamed, damaged nerve it does not recover instantaneously. The surgical procedure does not heal the nerve, only the body is capable of that. The goal of surgery is to create the best possible environment for the body to heal itself and to prevent further damage. This will take a variable length of time depending on the duration and degree of nerve damage and the body’s own healing abilities. Most of the healing occurs in the first few months. Pain, weakness, or numbness lasting more than six months will likely be permanent. Everyone has a different pain tolerance that will dictate the amount of pain medication required. A decreased dose and less frequent use of pain medication will occur during your recovery period. A gradual weaning of medications should begin as soon as possible, generally within 2 to 4 weeks. Conservative use of narcotic pain medication is advised. While using narcotic pain medication you SHOULD NOT drive. One should try non-narcotic medication, such as Tylenol and reserve narcotics for only the difficult times. Do not take anti-inflammatory medicines such as Celebrex, Advil, Aleve, or Motrin, as these may affect your bone healing for 12 weeks following your surgery. Narcotics will NOT be considered for refills at night or over the weekend, or holiday.

Home Activity

A well-balanced diet is necessary for good healing and recovery. This includes food from the four basic food groups: diary products, meat, vegetables and fruit.

The First Week

  • Early to bed, late to rise and frequent rest periods throughout the day. Get at least 8 hours of sleep each night. A disrupted sleep pattern is common after discharge from the hospital and will return to normal over time.
  • You may not drive, but you may be driven, for short distances, using proper restraints such as shoulder and lap belts FOR 4 WEEKS
  • No lifting of more than 4 pounds
  • May climb stairs with hand rail
  • Avoid sitting for longer than 20 minutes at a time
  • Begin a daily walking program with 1 to 2 blocks initially; schedule a daily time and increase distance daily.
  • Eat a regular, balanced diet.
  • Take medications as prescribed, using narcotics as needed. Avoid using NSAIDs such as Motrin or Advil. FOR 12 WEEKS.

The Second Week

  • Resume normal rising and retiring schedule, but continue to rest throughout the day.
  • Wear your brace as instructed.
  • You may not drive.
  • No lifting of anything weighing more than 4 pounds.
  • May climb stairs with hand rail
  • Continue scheduled walking, increasing distance and frequency as able.
  • May resume sexual relations when comfortable.
  • Begin narcotic weaning as pain diminishes, relying mainly on non-narcotic medications

The Third Week

  • Resume normal rising and retiring schedule, resting as needed.
  • May resume light work around the home; lifting not to exceed 10 pounds.
  • Continue scheduled walking.
  • Wear your brace as instructed.

The Fourth Week

  • Resume normal rising and retiring schedule, resting as needed.
  • May resume light work around the home; lifting not to exceed 10 pounds.
  • Continue scheduled walking.
  • Wear your brace as instructed.