Elbow Surgery

Loel Z. Payne, M.D.


􀀀 You may resume clear liquids and light foods after surgery (jello, soup, etc.)

􀀀 Progress to your normal diet as tolerated as long as you are not nauseated.

􀀀 Many surgeries are done without general anesthesia. This allows you to resume a diet quicker with less nausea.


Managing the pain:

There’s no two ways about it, elbow surgery is painful. I am going to describe the best ways I have found to try to manage that pain. The first 1-2 days are the hardest. Don’t worry, it will improve.

Before surgery you will be offered a nerve block which helps greatly with pain control and decreases your need to take narcotic medications. I would strongly encourage you to have the block as it does significantly help with pain after the procedure. Additionally, during surgery I will often inject a numbing medicine like novocaine that will give some pain relief for several hours after surgery.

It is important to begin taking your pain medication before this medicine wears off. This is usually about 6 to 8 hours after the procedure. However, it may be as little as 2 hours or (if you’re lucky) it could be 12 to 16 hours. It is important to stay on top of the pain as it is more difficult to catch up.

I do not use a “pain pump” which drips the numbing medicine continually into the joint for several days after the surgery. Several recent studies have shown an increased risk of damage to the joint cartilage and subsequent arthritis as a result of prolonged exposure to this medication.

I believe in using multiple different ways to reduce pain. Our goal is to reduce the amount of narcotics required to control the pain. Narcotic medications (morphine, Percocet (oxycodone), Vicodin (hydrocodone), codeine and Dilaudid) have significant side effects. They can easily become addictive. They can be overdosed, especially in patients already taking other sedating medication such as sleeping pills. Narcotics decrease the body’s trigger to breathe and I may prescribe a medication to reverse this narcotic side effect (Narcan) if you are currently taking anti-anxiety or sleeping medication. It is best to avoid these drugs (and alcohol) while on pain medication. Narcotics cause constipation. They alter your ability to concentrate, cause drowsiness and should not be taken while driving. They can cause hallucinations. They frequently cause constipation and a stool softner, such as Metamucil of Sennokot DS, should be taken daily while on them. They often cause nausea and a medication for nausea, such as Phenergan or Zofran, is often prescribed with them.

Patients with significant reactions to all narcotics, may benefit from a newer drug called Nucynta (tapentadol) that does not typically have the same side effects. However, it may not be covered by many insurance formularies.

If you experience itching, take over the counter Benadryl one half hour before your narcotic.

            Surgery pain stems from multiple factors and you should address each of these to control the pain. Below is a chart to explain our multimodal pain control plan.




Preoperative pain management

Postoperative pain management

  1. Nerve block – anesthesia injections numbing medication around the nerves that go to the shoulder
  2. Local injection of numbing medication at the surgery site
  3. Anti-nausea medication such as Zofran or Scopolamine patch is given
  4. Tylenol or an anti-inflammatory such as Celebrex may be given
  1. Tylenol 650 mg every 6 hours around the clock. Limit to 3000 mg daily and avoid if history of liver disease. Use continuously for 3 days and then as needed.
  2. Naproxen 500 (2 Aleve) every 12 hours OR ibuprofen 800 (4 Advil) every 8 hours. Take with food and avoid if history of ulcers, severe reflux or kidney disease. Continue for 5 days and then as needed.
  3. Oxycodone 5 mg 1-2 every 4 hours as needed. This is the narcotic and should be used sparingly. However, if pain is severe and uncontrolled with other methods, you may take 3 pills at a time for the first 24 hours. Percocet and Vicodin (Norco) already have Tylenol in them so do not take Tylenol if you are on these medications. Straight Oxycodone does not.

Ice (see below) is very helpful

Physical therapy – stiffness is a common source of pain and therapy is often started several days postop



Bandages & Sling:

􀀀 Your post-operative dressing is a large, white fluffy dressing and may include a splint to immobilze the elbow.

􀀀 Do not try to remove the splint unless instructed to do so.


Washing & Sling:

􀀀 Keep the arm dry until the splint and bandage are removed. You may want to place the arm in a large bag to shower but make sure it is sealed well at the top and keep the arm out of the water as much as possible.

􀀀 You will have a sling after surgery. You may remove the sling at night and when sitting. You should try to elevate the arm higher than the heart when doing so. Try to have the hand higher than the elbow and the elbow higher than the heart. This is the best way to prevent swelling in the hand. When sitting on a couch, prop the arm on an armrest higher than your heart. If laying down, keep the arm on top of your chest on a pillow with the hand higher than the elbow.


Ice & Activity:

􀀀 One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with the frequent application of ice. This is most important the first 48 hours following surgery. The ice pack should be large (like a big zip-lock bag or bag of peas) and held firmly on the area of your surgery. Apply for 20 minutes every hour while awake if possible. Look for signs of frost-bite especially during the first twelve hours when the skin around your shoulder may be numb.

􀀀 Try to keep your fingers moving after surgery to avoid stiffness. The splint is usually applied so you can bend the fingers to almost make a fist. Moving them as much as possible helps prevent stiffness.

􀀀 You may return to sedentary work or school in 4-5 days after surgery if your pain is tolerable.

􀀀 Avoid driving unless otherwise instructed by Dr. Payne.

􀀀 Avoid long distance travel during the first week after surgery to reduce your risk of developing blood clots.


Follow up appointment:

􀀀 We try to give all of our patients a follow-up office visit at the same time we schedule your surgery.

􀀀 I usually want to see my patients in the office 2 weeks after surgery.


What to watch out for:

􀀀 Pain that is not relieved by medication several days after the procedure.

􀀀 Drainage from the wound more than 2 days after surgery

􀀀 Increasing redness around the surgical site

􀀀 Fever greater than 101.5 degrees.