Your Hand/Elbow Surgery at HSS: What to Expect


Jaime Ortiz, MD
2005-2006 Regional Anesthesia Fellow, Hospital for Special Surgery

  1. The Weeks and Days Before Your Surgery
  2. The Morning of Surgery
  3. Anesthesia
  4. The Operating and Recovery Rooms
  5. Recovering in the Hospital

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: You will be referred to an internal medicine specialist for a medical evaluation and clearance for surgery. This clearance includes a history and physical examination as well as some laboratory tests. If your particular medical condition requires it, additional tests such as an EKG or chest x-ray 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 everything 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 (commonly referred to as an ‘IV’), 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 a consent form for anesthesia. Surgery on the hand or elbow at HSS is usually performed with an infraclavicular block along with IV sedation. This regional nerve block allows for surgery to be performed on the specific extremity without the need for general anesthesia and provides pain relief for several hours after the surgery.

An ultrasound is used to inject local anesthetic around the nerves going to your arm, making your arm numb to ensure you experience no pain during the procedure. Depending on the extent of the surgery, a catheter maybe placed to allow more local anesthetic to be injected around the nerves.

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. The 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, your postoperative pain will be managed with a combination of pain pills by mouth and an infusion of medication through either your IV or peripheral catheter that you control with a button. This is called PCA or patient controlled analgesia. If you are discharged home on the day of the operation, you will receive detailed instructions for taking care of yourself and a prescription for pain medication.

You will probably still be very comfortable because of the nerve block you received. How long the block will last varies and should be discussed with the anesthesiologist prior to the surgery. For optimal pain control, you should begin taking pain medication by mouth as you start to regain sensation in your arm. Your arm should remain in a sling until full sensation has returned.

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: If your surgeon requests consultation from our Acute Pain Service (APS), an anesthesiologist and nurse from the APS will visit you to evaluate and treat your pain. On the first day after surgery, you will be transitioned to oral pain medications. Once you are comfortable with the pain medication, the peripheral catheter will be removed. The Recuperative Pain Medicine Service (RPM) will ensure that a comprehensive and patient-specific discharge plan (including pain management) is in place for each patient, both during their stay at HSS and when they leave the hospital.

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.

Reviewed and updated by Dr. Devan Bhagat
Updated 12/5/2011 by Shawna Dorman, MD


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