Post-Operative Care

Post-operative recovery starts in the post-anesthesia care unit (PACU). This unit is dedicated to meeting the patient’s needs, thereby minimizing post-operative complications.

Although it may only have taken moments to surrender to general anesthesia, recovery from anesthesia takes time. Throughout surgery, the anesthesiologist maintained deep sleep using an anesthetic. During this time, muscles and fat absorb some of the anesthetic, which helps to maintain levels of anesthesia in the brain and blood.

This means that the body needs time to eliminate any remaining anesthetic in the body’s tissues. Many factors affect the amount of time a patient may spend in the PACU. These factors include the pre-operative medication, the type of anesthetic, and the length of time an anesthetic was administered during surgery. Hearing is the first sense to return following general anesthesia. This is why the PACU staff speaks in a reassuring tone while letting you know what they are doing.

In the PACU, you may wear certain devices to automatically monitor your vital signs. These devices include a blood pressure cuff, oximeter (records pulse), and EKG leads (monitors the heart). The IV will remain in place to deliver medication and fluids intravenously. A urinary catheter will collect urine to help the nurse monitor kidney function and hydration after many spine surgical procedures.

Every few minutes, a nurse will assess your overall condition. This helps to minimize post-operative complications. In addition, the nurse will place warm blankets around your body. It is common for patients to feel cold following surgery.

The effects of anesthesia linger following surgery, providing extended relief from pain. Other forms of pain management are used to augment the diminished effects of anesthesia.

Patient-controlled analgesia (PCA) is used post-operatively for pain control. This device allows you to self-dose pain-relieving medication at the push of a button. PCA is a computerized pump programmed to dispense small doses of pain medication through your intravenous line (IV). Your physician will set the parameters, so you only get the appropriate dose.

Pain medication is sustained to provide more consistent and better pain relief. Later, oral pain medications will replace PCA. You are encouraged to notify the nurse immediately if your pain is not sufficiently relieved.

Lying flat for long periods of time can cause fluid to accumulate in the lungs. The nurse will help you sit up, breathe deeply, and cough. This loosens secretions for elimination and helps to prevent pneumonia.

Deep breathing increases circulation and promotes elimination of anesthesia. You may be instructed to breath into a spirometer. A spirometer is a device used to measure how deeply you are able to breath (lung capacity) and acts as an incentive, so you will see just how deeply you are breathing.

When do I need to be seen in the clinic?

Your first office visit should occur 10-14 days after surgery. If you have been in the rehabilitation unit and have therefore been in the hospital longer, you should be seen in the clinic 14 days from the date of your discharge. Please schedule a follow-up appointment accordingly.

How do I manage my constipation after surgery?

This is a common problem after surgery due to the narcotic medication use. Being proactive in reducing symptoms is the key to a successful outcome. Be sure to start the following over-the-counter regimen as soon as you get home. Use each category together:

• Colace or Pericolace, 100mg table, twice a day ALONG WITH Milk of Magnesia, 30CC once a day
• Citrucel or Metamucil fiber supplements, twice a day
• A stimulant such as Senekot-S, Dulcolax suppository, or Fleet enema or equivalent if you have not had a bowel movement after several days

Continue your chosen regimen for two weeks or as needed. If you experience diarrhea, you may stop use.

What activities are permitted or restricted when I first get home?

• You will require frequent periods of rest. Fatigue is normal for the first 3 months.
• Walk as much as tolerated. There are no limitations, but you should listen to your body and rest when you are tired.
• Your exercise is limited to walking or using a treadmill and/or stationary bike.
• Limit sitting to 30 minutes at a time, no more than 4 times a day. Sitting for long periods will tend to make your back sore.
• Limit lifting to no more than 20 pounds.
• Use your lumbar corset/brace.
• When you feel you are ready, you may begin to wean yourself from use of the lumbar corset, walker, or cane.
• Do not lift, stoop, bend, or twist more than 20% of your normal range.
• Drive when you feel ready, but never under the influence of medications!
• Use a position of comfort and control when you feel you are ready to begin sexual activity.
• Use common sense with all of your activities.

What should I know about my medications before and after surgery?

• Narcotics and controlled substances, muscle relaxers, and/or sedatives are potent pain medications.
• They are used to control acute surgical pain and other pain syndromes.
• They have a high potential for psychological dependence (addiction) and/or physical dependence (tolerance/dependence).
• Do not drive, operate heavy machinery or dangerous equipment, or perform executive or critical decisions. The mediations you may be using can cause sedation or cognitive/motor impairment. Resume these activities if you can function without any physical impairment and if you have stopped taking the medications or they do not impose any unsafe side effects or risks.
• Stopping pain medication abruptly may lead to withdrawal symptoms. You may experience insomnia, irritability, agitation, headache, tremors, sweating, racing heart, runny nose or eyes, diarrhea, hot flashes, poor appetite, and increased pain.
• These symptoms usually last 3-7 days, depending on the medication and dosage.
• We recommend that you gradually reduce your dosage with these medications.
• Remember that various pain medicines can only be picked up in person at the pharmacy. Prescriptions for these medicines cannot be called in or faxed over to pharmacies. We expect you to adhere to the clinic prescription/medication refill policies and agreements.
• If these medications are required longer than necessary for chronic pain well after surgery, you will be referred to either your primary care physician or a pain specialist to help you continue with necessary pain management.

We do not manage chronic/long-term pain.

• Do not take medications/substances that have not been authorized by a physician. This includes over-the-counter remedies, herbal supplements, etc.
• Constipation will exacerbate your spine pain. Please follow the bowel protocol outlined above.
• Over-the-counter stool softener and/or fiber are recommended while you are taking pain medication.
• Spine Fusion Patients Only: Avoid non-steroidal anti-inflammatory drugs (NSAIDS), steroids, and cytoxic drugs (rheumatoid/anti-cancer agents) for the first 3-6 months, because these may inhibit bone growth. While medical literature on this topic is controversial, our neurosurgeons prefer to be conservative.

Other Concerns

• Use care when using stairs, walking on uneven surfaces, snow, ice, or anything that could promote a fall, especially within the first 6 months of surgery.
• A fall or other trauma has the potential of disrupting the surgical work performed on your spine.
• You may discontinue the TED hose/stockings one week after surgery only if you are walking frequently throughout the day.