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Advances in Hand and Wrist Arthritis Surgery.
Edited By: Thomas Trumble, M.D., Magee E. Saewert, MS, PA-C
Last updated Tuesday, March 28, 2006
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Recovering from surgeryPain and pain management Like many types of surgery for arthritis where segments of the bone are removed and/or replaced or tendons are repaired and reconstructed, the patients will have pain that needs to be managed by strong medications initially and then mild medications for long-term relief. Pain management is a key Component to successful recovery. The patients frequently receive a long acting pain medicine such as Oxycotin or MS Cotin prior to surgery as well as an anti-inflammatory medication to enhance the effect of the narcotics. This is given to the patients by the staff in the recovery room. After the surgery, the patients receive a strong medication such as morphine or fentyl, as well as a strong intravenous anti- inflammatory medication that has a significant affect on pain from bone and joint surgery called ketorolac. pain medications are frequently necessary three to four weeks after the surgery.Use of medications Patients frequently use pain medication on a regular basis for one week
after the surgery and then intermittently for an additional two weeks
but this varies widely based on each patient’s chemistry and the type
of procedure.Effectiveness of medications Pain medications can be very powerful and effective. The use lies in
balancing their pain relieving affect and their less desirable effects
for nausea, constipation, dizziness, etc. Good pain control is an
important part of post-operative management. A key factor is the
combination of long acting medications prior to the surgery and then
the use of local anesthetics during the operation to decrease the
patient’s need for narcotics. The more narcotics that are needed, the
more side effects that can occur.Important side effects Pain medications can cause drowsiness, slowness in breathing, and
difficulty in emptying the bladder, nausea, vomiting, and allergic
reactions. Patients who take substantial narcotic medications
frequently might find the usual dose of pain medication to be less
effective. For some patients balancing the benefit and side effects of
pain medication is challenging. Patients should be notify their surgeon
if they have previous difficulty with pain medication or pain control.
It is very difficult to select the correct of type of medication and
often times a trial period of one medication is necessary is necessary
before switching to a separate medication. The best predictors of
success of medications is the success of the given medication with a
previous operation.Hospital stay The patient is usually monitored for an hour in the recovery area.
Instructions for office appointments, post-operative instructions, and
pain medications are provided. The post-operative appointments are
coordinated with post-operative therapy. A family member or a friend
escorts the patients out of the surgery center. Dressings and plastic
splints are usually maintained until the patient sees the physician or
hand therapist. The drain, if necessary, is usually removed the
following day and instructions are provided for drain removal.Recovery and rehabilitation in the hospital After most procedures for hand and wrist arthritis, splints are
necessary for seven to ten days to hold the position of the
reconstructed tendons or joints and allow for the initial phase of
healing. Protection of the repaired tissues is usually required for an
additional month or for a total of six weeks from the surgery.
Additional splints or casts are applied in the office when the patient
returns for a follow-up appointment to have the sutures removed two
weeks after the surgery. Therapy needs to be carefully designed for
each type of procedure in order to prevent stiffness and enhance motion
while still protecting the repaired joint or tendons.Surgery for Hand and Wrist Arthritis at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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