- The Weeks and Days Before Your Surgery
- The Morning of Surgery
- The Operating and Recovery Rooms
The following is a helpful timeline to help you understand and prepare for your experience at HSS. Although the following outline of a shoulder arthroscopy is a typical one, please keep in mind that your experience may differ.
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. Elective surgery allows for advance consideration of work schedules, holidays, and upcoming family plans.
- Clearance: Weeks before the operation, you will have your surgery date set and see a medical doctor for a detailed physical examination and clearance for surgery. If your particular medical condition requires it, other tests might be needed before surgery, such as an EKG or a chest x-ray. On occasion, you might need additional testing, such as a cardiac stress test or echocardiograph.
- Medications: You may be instructed by your surgeon or primary doctor to stop certain medications (such as strong blood thinners like Plavix or Coumadin) several days to a week before your surgery. In addition, you may be instructed to take some of your medications the morning of surgery even though you won't be allowed to eat that morning. It is important for you to bring a list (or a bag of pill bottles) including all your medications to your medical clearance. This includes vitamins, over-the-counter medications, and supplements (a number of medications and supplements may interact with medications you might receive after surgery.)
The day before your scheduled procedure, a perioperative nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, and you will be reminded not to eat or drink anything after midnight. This does not apply to the 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 your 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 you will be prepared 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. There will be other patients in the room, all separated from each other by curtains for privacy. One member of your family can be with you during this time.
A nurse will introduce himself/herself, ask you questions pertaining to your surgery, and confirm the site of surgery before starting an intravenous line (most commonly called an “IV”) to give you fluids, with minimal discomfort. The nurse will explain that this procedure is necessary to perform the surgery safely as well as to provide sedation, and that it has to be placed in the hand opposite that of the site of the operation. If you are a woman of child-bearing age, you will be asked to provide a urine specimen for a pregnancy test.
- The Pre-operative Exam: A Physician’s Assistant (PA), 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 to sign consent for that surgery if you have not already done so. Your surgeon will come to speak to you and 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.
The anesthesiologist will review your medical history and chart, while confirming the correct site of the operation, and explain the anesthetic plan. At HSS, most shoulder arthroscopies are done under regional anesthesia with sedation. Regional anesthesia entails a nerve block of the brachial plexus. Local anesthetic is injected around the nerves going to your shoulder to numb your arm so you do not experience any pain during surgery. An ultrasound is used for the nerve block to ensure the local anesthetic is injected into the correct location. As a result of using regional anesthesia, you will require less sedative and pain medication, which will enable you to recover faster, feel more comfortable, and experience fewer side effects, such as sleepiness and nausea. You will be sedated prior to the nerve block and placed in a deeper sleep for the surgery. After having all of your questions answered, you will be presented with the anesthesia consent form.
The Operating and Recovery Rooms
- Anesthesia/Surgery: After your consultation with the anesthesiologist, you will be taken to the operating room by your nurse. Once there, your anesthesiologist will measure your blood pressure and heart rate and provide supplemental oxygen via a nasal canula, which is a small tube under your nose. He/she will then begin giving you sedative medication. Anesthesia will be administered, and the surgery will then begin. When the surgery is complete, your surgeon may speak with your family and you will be taken to the recovery room.
- Recovery: In the recovery room, you will wake up from the sedation. Your arm and shoulder will likely be numb and weak. In addition, you may notice that your voice is a bit hoarse or your chest may feel heavy, which is normal after a nerve block for shoulder surgery. As you become more awake, you will be given a light snack and drink and will be able to receive visitors. Your surgeon or member of the surgical team will speak to you about the surgery.
After postoperative instructions and prescriptions for pain are administered, you are ready to go home. As your anesthesiologist will explain, you may feel some residual numbness in your shoulder and fingers, which can last for several hours. As the numbness wears off, you will start to take the prescription given to you for pain as instructed. Keep your arm in a sling until your arm has full sensation in order to prevent injury to your arm.