Pre-Op and Surgery Day

Pre-Operative Procedure

Dr. Rector generally sees patients for a pre-operative appointment 2 or 3 days prior to surgery. During this visit, Dr. Rector will review the procedure with you and answer any questions. At that time your medical history will be obtained and a physical examination will be performed. Please bring a complete list of your current medications and dosages to that appointment.

A device called an OrthoPAT will collect and process the blood you lose after surgery, so that it can be transfused back to you. Transfusions of other people's blood are rare. If you have a strong desire to pre-donate your own blood, please notify Dr. Rector or Michelle at the time you schedule your surgery. Although Dr. Rector does not generally recommend pre-donation, he will be happy to arrange it if you wish.

At the completion of your appointment you will be given a packet of information which you will take to Boulder Community Hospital for your pre-operative appointment there. The packet will contain your operative consent form, your pre-operative orders and other pertinent information.

Preparation for the Hospital

You may want to bring the following items to the hospital:

• Clothing: underwear, socks, t-shirts, exercise shorts for rehabilitation
• Footwear: walking or tennis shoes for rehab, slippers for hospital room
• Walking aids: walker, cane, wheelchair, or crutches if used prior to surgery
• Insurance information

Before Surgery, You Should Adhere to the Following:

• You should follow your regular diet on the day before your surgery.
• DO NOT EAT OR DRINK AFTER MIDNIGHT the night before surgery. On the morning of surgery, you may brush your teeth and rinse your mouth, but do not swallow any water.
• Follow your doctor’s instructions regarding use of medication in the days leading to surgery. In general, aspirin, non-steroidal anti-inflammatory medications, plavix, and coumadin should be discontinued 5 to 7 days prior to surgery. Use extra-strength Tylenol for pain or ask Michelle for Celebrex samples to use for several days prior to surgery. These will not increase your bleeding at the time of surgery.
• Try to get long, restful nights of sleep. A sleeping medication may be ordered the evening before surgery.

Day of Surgery

Dr. Rector performs surgery at Boulder Community Hospital, located at Broadway and Balsam in north Boulder. Operating days are Monday afternoons and all day Wednesdays and Fridays.

On the day of surgery, you should plan to arrive at the hospital 1 1/2-2 hours prior to your scheduled surgery time. The nursing staff will take your vital signs, start intravenous (IV) fluids, and administer medications as needed. You will be asked to empty your bladder just prior to surgery, and to remove all jewelry, contacts, etc. (Rings not removed will be taped.)

Prior to going to the operating room, you will meet your anesthesiologist. He/she will review your medical history and discuss your options for anesthesia. Dr. Rector generally recommends a combination of spinal anesthesia and general anesthesia. Medication can be added to the spinal that provides pain relief for up to 24 hours. With general anesthesia, you will feel no pain and will not be aware of sounds in the operating room.

Surgery and Recovery

The surgery usually lasts about 2 hours. At the completion of the procedure, you will be taken to the recovery room. Dr. Rector will come to the family waiting room then and speak to your family. You will be in the recovery room 90 to 120 minutes, where your blood pressure, heart rate, respiration, and body temperature will be closely monitored by the recovery room staff. Special attention will be given to your circulation and sensation in your feet and legs. Your family is not allowed into the recovery room. When your condition is stable and you are fully awake, you will be transferred to your hospital room. Your family will be notified and can join you there.

Medication used in the spinal anesthesia can provide post-operative pain relief for up to 24 hours. Most patients experience mild itching and nausea secondary to the medications used in the spinal. With the pain relief afforded by the spinal, most patients can progress directly to oral pain medication, such as vicodin or percocet. A patient-controlled anesthesia (PCA) pump for intravenous morphine is available if necessary and requested. A catheter will be inserted into your bladder in the operating room after you are asleep. It is usually removed in the morning of the first post-operative day.

You may awaken to some or all of the following:

1. Your incision is glued. No external stitches are staples are used. The wound is covered with a waterproof plastic dressing. You may shower at any time.
2. You may see a hemovac suction container with tubes leading directly into the surgical area. This device allows the nurses to measure and record the amount of drainage from the wound following surgery.
3. An IV will continue post-operatively in order to provide adequate fluids, antibiotics, and other medications. You will receive antibiotics for 24 hours following surgery. Please notify Dr. Rector if you are allergic to certain antibiotics.
4. A catheter may have been inserted into your bladder as the side effects of medication often make it difficult to urinate.
5. An elastic hose may be applied to decrease the risk of deep vein thrombosis (DVT). Compression devices will be applied to your legs to decrease the risk of DVT.
6. A patient-controlled analgesia (PCA) device may be connected to your IV, allowing you to control the relative amount and frequency of pain medication. To prevent overdose, the unit is programmed to deliver a pre-defined amount of pain medication anytime you press the button of the machine.