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Post Operative Instructions after Distal Biceps Repair Helpful Hints & Important Precautions for Patients

Diet

• 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.

Medications:

• Before surgery you will be offered a nerve block which helps greatly with pain control and decreases your need to take narcotic medications. It is important to begin taking your pain pills before this medicine wears off.
• This first medication I use is Norco which is a strong narcotic pain medication. It will begin to work within 15 minutes after taking it with a maximal effect in one to two hours. Normally, Norco is taken 1 pill every 6 hours but if the pain is severe, it can be used 2 pills every 4 hours.
• Common side effects of the medication are nausea, constipation, itching, and drowsiness.
• The best way to prevent nausea is to take the medicine with a little food, start with just one pill, and be patient while the medicine begins to work. Usually, after the first few doses the nausea will go away. I also prescribe an anti-nausea medication called Zofran (Odansetron) to be taken if you have persistent nausea after surgery.
• I strongly recommend you take an over-the-counter stool softener starting on the day of surgery such as Colace 100 mg 2 tablets a day and a laxative such Miralax to avoid constipation.
• Take Benadryl one half hour before your narcotic if you experience itching.
• Transition from Norco to Tylenol as your pain subsides, but pay attention to the dosage as Norco has 325 mg of Tylenol in each pill. Patients with normal liver function should not consume more than 4000 mg of Tylenol per day.
• You will also be given a prescription for Naprosyn which is a strong anti-inflammatory medication. Take this twice a day with food in addition to the Norco. Both medications with work synergistically in pain relief.

All non-narcotic medications will be called into your pharmacy prior to surgery.

Bandages & Sling:

• If Dr. Sablan places you in a hard splint this should be kept clean and dry until your first post- operative visit.
• If Dr. Sablan does not place you in a splint but a soft dressing it is okay to remove this in 2 days, place Saran Wrap over dressing, and shower over the butterfly bandages (steri-strips).
• You will have a sling placed after surgery.

Ice & Activity:

• One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with elevation of your elbow above the level of your heart. Try to avoid having your hand hanging down for extended periods of time.
• I encourage the frequent application of ice. This is most important during the first 48 hours following surgery. The ice pack should be large (like a big zip-lock bag) and held firmly on the area of your surgery. Apply for 20 minutes every hour while awake if possible.
• I encourage you to move your wrist and fingers as much as possible as this will improve your chances of an early recovery and decrease your chances of developing stiffness.
• You may return to sedentary work only or school in 3-4 days after surgery if your pain is tolerable.

Sleeping:

• Many patients have difficulty sleeping after elbow surgery. You may find that sleeping in a slightly upright position (ie reclining chair) with a pillow under your forearm will be your most comfortable position. Make sure to have your pain under control before you sleep.

Hand Therapy

• The goal of hand therapy is to first assess how your body responded to the surgical procedure. They help you feel comfortable with your surgery and make sure you aren't afraid to start doing things. Your therapist will start range of motion and exercises on your first visit.
• Dr. Sablan may start hand therapy after your first post-operative visit, depending on the findings during surgery.
• Depending on the strength of your tendon, Dr. Sablan will place you in a brace and discuss restrictions with your hand therapist.

Follow up appointment:

• We try to give all of our patients a follow-up office visit at the same time we schedule your surgery.
• Typically I want to see my patients in the office 5 to 10 days after surgery.

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FOLLOW UP APPOINTMENT:                                    

What to watch out for:

∞ Pain that is increasing every hour in spite of the pain medication

∞ Drainage from the wound more than 2 days after surgery

∞ Increasing redness around the surgical site

∞ Pain or swelling around your surgery

∞ Fever greater than 101.5 degrees.

∞ Unable to keep food or water down for more than one day