Post Op Instructions

The following medication recommendations are generalized and may not apply specifically to you as medication allergies or certain medical problems may limit the use of some pain medications. You should have been given instructions about your pain medications when you were discharged. If you have specific questions about your medications, please call Dr. Jeffers.  

IF YOU HAD ARTHROSCOPIC OR OUTPATIENT SURGERY:  You may have been given a prescription for a strong pain medication. The usual dose is one pill every six hours. However, if your pain is not under control, you can take one pill every four hours. If one pill doesn't help, you can take two pills every six hours, but be careful not to exceed 12 pills in a 24-hour period. It's important to try to take the smallest amount of pills necessary to manage your pain. Taking fewer pills will help minimize the side effects such as constipation, nausea, vomiting, dizziness, and confusion. If you find that the medication is too strong, you can use plain Tylenol (acetaminophen) instead. Medications like Motrin and Aleve, which reduce inflammation, can also be effective, but they may increase the risk of bleeding.

If you find yourself taking both the narcotic and extra Tylenol (acetaminophen), please be aware that most narcotic pills are combination medications containing both Tylenol (acetaminophen) and the narcotic.  The pill bottle will list the 2 medications on the label.   (NOTE:  Dr. Jeffers will sometimes prescribe straight oxycodone; this narcotic is not mixed with Tylenol.  Your pill bottle label will tell you exactly what you are taking). You will need to monitor exactly how many milligrams of Tylenol you are taking.  Taking over 4000 mg of Tylenol (acetaminophen) in a 24 hour period will damage your liver and potentially cause liver failure.  Ideally, you should try to limit your intake of Tylenol in 24 hours to 3000 mg so you don't overly stress your liver. Most narcotic pills contain 325 mg of Tylenol and plain Tylenol comes in 250 mg, 500 mg, and 650 mg pills. Look the Tylenol package or bottle to determine the strength. 

IF YOU HAD MAJOR SURGERY SUCH AS A JOINT REPLACEMENT:  You had pain before the surgery; there will be pain after the surgery as well.   For the first few days after surgery, you should NOT expect that the pain medications will make you pain-free,  The overall pain control goal is to make your pain tolerable and manageable.   

You have been given a prescription for 3 different pain medications:  acetaminophen (Tylenol), ibuprofen (Motrin) and Oxycodone. The Tylenol and Motrin are your main medications; the oxycodone is to be used only if the Tylenol and Motrin are not controlling your pain. The medications work best as follows:

1.  Take 1000 mg of acetaminophen (500mg tablets x 2) and 400mg of ibuprofen together every 8 hours around the clock for 2-3 days

2.  Start the taking them the day of surgery, even if you are not in much pain

3.  The medications work better if you keep a constant amount in your body so it is good to set an alarm to take the pills and even wake up to take them

4.  After 2-3 days of taking the pills around the clock, you can start to take the pills only as needed for pain but don’t take them more often than every 8 hours

5.  If you find your pain is not controlled adequately with the acetaminophen/ibuprofen, you can take the Oxycodone (5mg) but no more than 1 pill every 6 hours

6.  You should not expect to be pain free for the first few days or weeks.  The pain should be manageable and tolerable.

7.  Based on your personal medical history, Dr. Jeffers may have given you either different medications or different instructions. If so, follow the instructions on the pill bottles.

8.  If you feel that you are having too much pain, call Dr. Jeffers

ICING:  Cold therapy is often very helpful. You may place ice, cold packs, or a bag of frozen vegetables over the surgical site for as much and as long as you want but please be cautious of causing frostbite.  It is recommended to place a towel between the ice and the skin to help protect the skin.  The pain will likely vary in the days after the surgery but the overall intensity should decrease with time.  If your pain continues to get worse and never improves, call Dr. Jeffers. 

IF YOUR SURGERY WAS NOT A JOINT REPLACEMENT:  You may remove the bandage the day after surgery unless you are told not to do so by Dr Jeffers. It is not unusual to see some blood on the gauze pad after removing it for the first time. If there is continued drainage, apply another clean dry gauze. There will a plastic bandage directly over the incision(s).  Leave the plastic bandage on the skin and let it fall off on its own.  If you are in a splint and it feels too tight, you may loosen the Ace wrap holding the splint in place but leave the splint on.   

JOINT REPLACEMENT PATIENTS (Hip, Knee, Shoulder):  You have 2 bandages protecting your incision but one is underneath the other and not visible until the outer one is removed.  Both are waterproof.  There is no need to remove either dressing until you follow up with Dr. Jeffers. It is best to leave both dressings in place if possible.  Occasionally, you may note a little bit of bloody drainage on the outer dressing.  If it has not soaked the entire bandage, it is OK to leave the dressing alone. If you think there is too much drainage, call Dr. Jeffers.  If Dr. Jeffers gives you permission to do so, it is OK to remove and change the OUTER bandage ONLY.  Leave the clear plastic bandage that is directly on the incision alone. 

IF YOUR SURGERY WAS NOT A JOINT REPLACEMENT: Keep the incisions dry for at least 1 day.  Unless told otherwise by Dr. Jeffers, it is Ok to get the incisions wet after the outer bandage has been removed. Leave the plastic bandage that is directly on the incision alone; it is OK to get it wet. Letting water run over the incisions in a shower is OK.  Don't soak the incisions in either a bath or Jacuzzi until you are told it is safe to do by Dr. Jeffers - usually 4-6 weeks after the surgery.  

JOINT REPLACEMENT PATIENTS (Hip, Knee, Shoulder):  Both of your dressings are waterproof.  You may start to shower and get your bandages wet 1 day after surgery.  Do NOT soak your incisions in either a bath or a hot tub.  Letting the water run over the dressings is OK.  Gently pat the area dry after the shower and try not to disturb the dressings. The dressings are intended to stay in place for 2 weeks.  Once the dressings have removed by Dr. Jeffers, it is still OK to shower and to get the incision wet.  Don't soak the incision in either a bath or Jacuzzi until you are told it is safe to do by Dr. Jeffers - usually 4-6 weeks after the surgery.  

DEEP VENOUS THROMBOSIS (DVT):  One of the more concerning problems that can happen after surgery is the formation of a clot within the deep veins on the legs; a deep venous thrombosis or DVT.  If the clot breaks loose, it can travel through the veins back to the heart and then the lungs. This is called a pulmonary embolism, or PE.   If the clot is big enough, it can stop blood flow in your lungs and make it difficult to breathe.  Rarely, the blood clots can be fatal.  Luckily, most surgeries have a low risk of DVT formation but there are some types of surgery in which the risk is high. Unfortunately, there is no way to completely eliminate the risk of DVT formation after surgery.  

THINGS YOU CAN DO TO PREVENT DVTS:  While Dr. Jeffers does many things during the surgery to reduce your chance of DVT formation, there are actually many things you can do yourself to prevent the DVTs from forming, as they can occur even when you are at home. For most surgeries, the most important thing you can do is try to remain active and keep your legs moving.  Walking, or even just moving your ankle and knee, activates the muscles in your legs and helps push the blood back to your heart.  Try to get up and walk 3 to 4 times a day, even the day after surgery.  You don't have to walk far.  Staying hydrated also may help as well. 

BLOOD THINNING MEDICATIONS:  For most outpatient surgeries the risk of DVT is low and no additional medications are indicated to prevent DVTs.  For certain surgeries though, joint replacements in particular, the risk of DVT formation is high.  In addition to the walking, Dr. Jeffers most likely prescribed you a blood-thinning medication.  For most patients, this will a baby aspirin but it may a different medication. The most important thing is to take the medication as prescribed. The medication, dosage, and length of time you should take will vary based on your particular medical problems.   You should have been given instructions on how to take the medication on your discharge, but if you have questions, call Dr. Jeffers. 

IF YOU SUSPECT YOU HAVE A DVT:  If you suddenly develop chest pain or find it difficult to breath, call 911 or go directly to the Emergency Room.  You may have developed a pulmonary embolus (blood clot in the lung) and you should seek urgent medical treatment.  Luckily, pulmonary emboli are rare and so this is uncommon.  A DVT that forms but hasn't broken loose yet also needs medical treatment sooner rather than later.  Unfortunately, diagnosing a DVT based on physical examination alone is actually quite difficult.  The most common symptoms of a DVT are pain in the calf and swelling.  Trying to tell the difference between the pain and swelling from a DVT and pain and swelling that normally is present after surgery can be a challenge.  While pain and swelling are completely expected after surgery, if you think the amount of pain and/or swelling is more that you would expect, call Dr. Jeffers.  If you are unable to reach him quickly, consider going to the Emergency Room. There, they have the tools to quickly evaluate you for a DVT and also start treatment if needed.  

WALKER OR CRUTCHES:  Unless you were given specific instructions not to, it is OK to place all of your weight on your legs. even the one that had the surgery.  Use the walker or crutches until you regain your feeling of balance.  If you feel unsteady, continue to use the walker or the crutches. Once you start to feel more comfortable, you can use the device less and less. Most knee arthroscopy patient will feel comfortable walking without crutches after 2-3 days but you can use them for a longer or shorter time.  For joint replacement patients, you can transition to a cane from the walker when you feel comfortable to do so. If you don't think you need a cane, that is fine too. Most patients transition to starting walking without assistive devices in their house but will continue to use the device (just in case) when they leave the house.  The key concept is a feeling of balance and stability...continue to use the walker, cane or crutches if you feel unsure of your stability. 

SLING:  Depending on the specific surgery you had, Dr. Jeffers will give you personalized instruction as to which shoulder and arm movements you should avoid.  The sling is supposed to help with support and helps keep your arm close to your body.  You may use your hand as much as you would like, even within the sling.  You can use your hand and arm for feeding or personal care  but don't lift anything heavier than a full coffee cup.  It is recommended that you remove the sling 2 to 3 times a day so that you can fully stretch your elbow so it does not become too stiff.  You don't necessarily need to wear the sling 24 hours/day and so you may remove it from time to time if it becomes uncomfortable.  If you do remove it, keep your arm close to your chest and don't do the specific motions of your arm and shoulder that Dr. Jeffers told you not to do. 

If you have any of the following conditions below, please call Dr. Jeffers right away.  If you can't get a hold of him, consider going to the Emergency Room. 

Continuous, active bleeding or drainage from your wound

Pain that continues to increase and does not improve despite the use of pain medications

Chest pain

Difficult breathing

Most likely, you will not have any of the above problems. However, if you are concerned about something and you are not sure if the problem can wait until the follow up appointment, please feel free to call Dr. Jeffers at any time, day or night, 805 981-1788.  If it during office hours, his secretary will pass the message along.  If it is at night, or on the weekend, his Answering Service will contact him and he will call you back.  If he does not contact you right away and you don't feel you can wait any longer, consider going to the Emergency Room.  

Please call for an appointment for the week following your surgery.  (805) 981-1788

If you have had a joint replacement (knee, hip, or shoulder), you should follow up 2 weeks after your surgery.