Pre and Post Operative Instructions

PRE AND POST OPERATIVE INSTRUCTIONS FOR PATIENT
Dirk Lazarus (Revised 22 November 2022)

Please keep this document handy for reference during your recovery.
This document is available at www.plasticsurgery.co.za/instructions (you are here already).
I appreciate reviews: https://g.page/r/CdGtpr3bxVwBEBM/review.

My aim is to get you through your surgical experience as safely, as simply and as comfortably as possible.

Pre-operative preparation at home for recovery

Before surgery ensure that you are well prepared at home. Have enough food at home. Laundry done. Work done. School lifts and lunches for the kids arranged, that kind of thing. Don’t set commitments for after surgery – clear your diary. Make sure you have everything you will need at home before surgery.

After surgery allow yourself the time and space to recover. Post-operatively it is important to rest. Rest facilitates healing and you will feel better if you rest properly. Initially, until you feel better, try and move, especially the operated area, little. Bed or chair is advised.

Diet

Eat healthily before and after surgery.

It might be beneficial to take Vitamin C and Zinc supplementation to aid in wound healing.
Avoid Aspirin containing medication, anti-coagulant medication and all supplements (apart from the above) for 2 weeks prior to surgery as these can cause bleeding issues.

Ensure that after surgery you drink sufficient fluid so that you are passing good volumes of pale urine.

Smoking, supplements, medications

Cigarette smoking impairs wound healing and you should not be smoking or taking nicotine replacement products (gum, vape, patch) for one month before or after surgery.

Most supplements should be avoided before and after surgery. Mineral supplements (zinc, magnesium, iron, calcium) and vitamin supplements are generally okay.

Homeopathic supplements – Arnica, St John’s Wort, Rescue remedy should be avoided as they can cause bleeding. Arnica can started 2 days after surgery if you want, although I am dubious that it has any benefit

Blood thinners like Warfarin and Xarelto need to be stopped at least a week and preferably 2 weeks before surgery. Aspirin containing medication also needs to be stopped for 2 weeks before surgery.

Regular medication like blood pressure meds, HRT can taken as usual with a small sip of water.

Before you come in to the clinic for surgery

You need to be Nil By Mouth: You should not eat or drink for 6 hours prior to surgery. On the morning of surgery, you can brush your teeth, but not drink.

Preferably no nail polish, especially gels, no jewellery, no valuables.

Collection from the Clinic

After any sedation or general anaesthesia you will need to be collected from the clinic by a responsible adult.

Sleep

Sleep aids recovery. Ensure that you get adequate sleep and rest before and after surgery.

If you think you will need sleeping pills before and/or after surgery then please let us know. We usually use Stilnox 10 mg – take half or one tablet before bed.

More information: http://www.sanofi.com.au/products/aus_cmi_stilnox.pdf

For facial surgery it is advisable to sleep with your head elevated for the first few nights.

Hygiene: washing and bathing

Bath or shower the night before and the morning of surgery and wash the area to be operated on well. You can use an anti-bacterial soap  although any soap will do. Wash your hair prior to surgery.

Do not apply make-up  (for facial surgery) or body lotion (for body surgery) on the day of surgery.

Post-operative washing instructions depend on the area operated on. Generally try to keep white dressings dry although if they do get wet you can gently dab them (although that will not necessarily dry them). Often I use clear plastic type dressings which can withstand some water and get wet, ie you will be able to shower.

With facial surgery, be careful of hair dryers after surgery. Do not use on them on a hot setting. Sensation is likely to be impaired after surgery and you can get burned.

Pain

Surgery is never completely pain free, but in general plastic surgery procedures are not that painful and are bearable. We will try to reduce your pain to a level which is easily tolerated. We have a step-wise approach to pain management so as to provide optimal pain relief with minimal side effects. The more steps you go up, the higher the risk of side effects, particularly nausea and vomiting.

Step 1: Paracetamol 1 tablet plus Stilpane 1 tablet. Take both together every 6 hours.
1 tablet of Paracetamol contains 500 mg of paracetamol.
1 tablet of Stilpane contains 320 mg paracetamol and 8 mg codeine.
The two together optimise the paracetamol dose and the codeine works synergystically with the paracetamol. Codeine can cause gastro-intestinal side effects including constipation.
After a few days, when the pain is less, stop the Stilpane and continue with the Paracetamol only, 1-2 tablets 6 hourly as needed for pain.
Alternative to Stilpane: Myprodol (250 mg paracetamol, 10 mg codeine and 200 mg Ibuprofen).
The anaesthetist may prescribe alternatives to the above.

Step 2: Add anti-inflammatory: Celebrex 200 mg or Xefo 8 mg, morning and evening.
Xefo should be taken 15 minutes prior to meals.
Celebrex should be taken after meals.
These only need to be taken for pain. If you pain is well controlled, don’t take, they can have gastro-intestinal side effects including heartburn and nausea.
The anaesthetist may prescribe an alternative, eg Brufen.

Step 3: Add opiate: Oxynorm, Targinact or Tramacet. These can also nausea and vomiting and so you should only use them for break through or severe pain. Once the pain is controlled, don’t take them. Being opiates, these are highly addictive.
The anaesthetist may prescribe an alternative.

More information:
Paracetamol: http://home.intekom.com/pharm/gulf/von-pmol.html
Stilpane: http://home.intekom.com/pharm/lennon/stilpant.html
Mypradol: http://home.intekom.com/pharm/adcock/myprod-c.html
Celebrex: http://home.intekom.com/pharm/searle/celebrex.html
Oxynorm: https://www.drugs.com/uk/oxynorm-10mg-capsules-leaflet.html

Bowel actions

Because constipation can be a problem after some surgery and a side effect of the medication, if you are prone to constipation we can prescribe Movicol.
More information: https://www.drugs.com/uk/movicol-sachets-leaflet.html

Mobility and exercises

To improve circulation and reduce the risk of leg clots (DVT, deep vein thrombosis) it is advisable not to remain totally bed bound during the day, but to move around a bit. Start walking. Also, while in bed do leg exercises, flexing your toes and ankles, holding them flexed and then extending them and holding the extension. Similarly knee bends are useful. Ten an hour every hour. These are the routine anti DVT exercises that are advised to do when you fly. Most patients will receive a DVT risk assessment prior to surgery.

Getting up from bed should be done in stages. The risk is fainting due to blood pressure changes which can occur after surgery. It is advisable to go from lying to sitting, then sit awhile until you are sure that you feel fine and not light headed. When you move from sitting to standing, stay near the bed in case you need to lie down again.
If you feel light headed at any time lie down immediately. You don’t want to fall and injure yourself. Stay well hydrated by drinking plenty. You know you are well hydrated if you are passing large quantities of pale urine.

Driving can usually be resumed about a week after larger operations.

Walking and gentle stretching can be done, but gym and heavy exercise should not be resume until 6 weeks after surgery.

Compresses

Do NOT apply hot or cold compresses after surgery. Post-op sensation is diminished and compresses can cause vascular compromise or thermal injuries like burns. The only exception is for eyelid surgery where where cooling may be comforting and help with swelling. Cooling of your eyelids can be done as follows: combine ice and water in a bowl and circulate two face clothes between the iced water and your eye area – one in the bowl of water/ice and one on your lids.

Dressings

Dressings are placed to protect the wound and frequently to keep sutures in place. Unless otherwise instructed, do not remove or disturb your dressing. Do not remove or cut any sutures. If you feel you need a dressing change, please contact the rooms to arrange to come in to have the dressing inspected and changed by us. I usually use a thin, plastic, waterproof dressing. You can shower with this dressing. It is not unusual for some blood to collect beneath the plastic. A few drops of blood will spread out and look significant. This is usual and not concerning.

I will do the dressing changes at follow up. If you are scared this may be painful, you can take a paracetamol or two about 30-40 minutes beforehand, but it is not usually noticeably sore.

Monitoring for complications or problems

Complications are rare and if they occur they will usually be obvious to you. You do not need to do any specific monitoring, but what is described below are a few details about the most important issues which can arise. If a complication does arise then I will deal with it as appropriate.

The complication that I am most concerned about early after surgery is bleeding. Internal bleeding will be evident as swelling, bruising and pain, usually markedly different from the other side. If this occurs contact me immediately. I will usually ask you to send me a selfie of the area and arrange to see you with a view to a return to theatre to evacuate any blood collection and control the bleeding. Sometimes a little blood will by bypass the dressing and trickle down. If this happens you can apply gentle pressure over the area. If you are concerned then contact me, number below. A small amount of bleeding can be expected after surgery, but if you are concerned, then check with me.

Infection, if it occurs, is a later event, occurring days after surgery. It is characterised by pain, warmth, swelling. A discharging wound is also a sign of infection. Like bleeding, if it occurs it is usually obvious. Again, you should contact me if you are worried.

A painful swollen calf might be indicative of a blood clot. The only way to confirm this would be to send you for a scan. The risk of this is lower with ambulatory surgery (day case surgery) and if you do your calf (airplane) exercises: toe curls, ankle flexes, knee bends. Walking a little also helps.

Concerning Issues

Breast surgery: one breast swells and bruises significantly differently from the other side.

Facial surgery: one side swells and bruises significantly differently from the other side.

Liposuction: You should be passing good quantities of pale, dilute urine. Dizziness, light-headedness and dark, poor or no urine output are concerning.

Check ups

Please check in with me on WhatsApp the day after your surgery. Anneli will give you my contact details and arrange further follow ups in the rooms based on my instructions.

Regarding WhatsApp: Please note that my WhatsApp is for early post-operative communication or emergencies. I would rather hear from you if you are concerned and mostly patients simply require reassurance. Complications are rare, but if there is concern I will arrange to meet you in the rooms.

In-Rooms Check Ups: These are arranged on a case by case basis, but generally there will be several so that I can change dressings, remove sutures, check your progress, deal with concerns, etc.

Non-Urgent Issues: Call the rooms, schedule to come and see me.

Whom to contact

Dr. Lazarus: 082 656 1961. You can send a Whatsapp picture of the operated area any time.

Danni will usually call or message patients the night before surgery, the evening of surgery and the morning after surgery. Ensure that your phone is on and that you can take her call (private number).

Feedback and rating

If you are satisfied please give me a review on Google. Reviews are very much appreciated, so here is the link https://g.page/r/CdGtpr3bxVwBEBM/review.

Thank you for trusting me with your surgery.