After Surgery

Immediately after surgery, you will wake up in the recovery room. Dr Kohan and his staff monitor you, checking your blood pressure, temperature and pulse. Dr Kerr will assess your pain. Also a post-operation x-ray will be performed in Recovery. Discharge from the hospital will be after Dr Kohan, Dr Kerr or Rebecca sees you.

Medications

During the Operation

Pain management will begin in the Operating Room while you are still under anesthetic. At the time your knee will be extensively injected with long-acting local anesthetic and the drug Toradol. This should give you a very good pain control for about 20 hours.

In the Recovery Room

• As soon as you wake up in Recovery, you will be given a loading dose of 4 Neurofen tablets.
• Sometimes we need to fine-tune things a little to make you completely comfortable, and we may need to do any of the following; inject some more local anaesthetic, give you some Panadeine Forte tablets, give you a small dose of Pethadine.

Regular Medication

For the next 3 days you need to take:

• 2 Neurofen tablets every 4 hours.
• 1 Renedadeine (Zantac tablet) night and morning.
• Metamuesil or Normacol night and mornings.

As the Local Anaesthetic Wears Off

Somewhere between 10 and 30 hours (usually about 20 hours). After the operation a local anaesthetic injection into your knee will begin to wear off, and your knee will start to feel uncomfortable. At this time you should

• Have an intra-muscular injection of Toradol.
• Take 2 Panadeine Forte tablets.

If you intend to go home straight after your operation, it is important to make arrangements to get a Toradol injection in advance. Your local doctor, nurse, home nursing service, or the nearest 24 hour clinic can give you the injection, but you must take this form, together with the ampoule of Toradol we supply to the person who will give your injections.

After the 1st Toradol Injection

The discomfort should ease considerably for about 6 - 8 hours after your Toradol injection. You may have a second injection of Toradol no sooner than 8 hours later, if your knee is becoming too uncomfortable. If you knee is comfortable you can skip this dose of Toradol. Panadeine Forte tablets can also be taken four-hourly, as required, but only take them if you need them, as they can cause nausea and constipation. You will probably need to take at least some Panadeine Forte tablets, but they should be kept to a minimum. It is often wise to take 1 or 2 Panadeine Forte tablets before you get into bed at night.

Notes

• You should get all the medication, 2 syringes, 2 needles, and an alcohol swab, before you leave the hospital.
• Panadeine Forte may cause nausea, if the dose is too high. If you start to feel nausea, halve the dose of Panadeine Forte.
• Panadeine Forte causes constipation. To help prevent constipation, you should drink plenty of water, and take fiber containing stool softener, such as Metamuseal/Normacol night and morning.

Pain medications can be reduced after 3 days. Stop the Panadeine Forte first, and then reduce the Neurofen tablets to 2 every 6 hours as the pain subsides. By 7 days post-operation you may like to change to Voltaren twice daily, if any pain medication is needed. If you have any problems, contact Dr Dennis Kerr on 0414 332 555.

Post-operative care

Incision Care

The incision is closed with skin staples. These need to be removed 5-7 days after surgery. You may change the gauze dressing as needed, to keep the dressing clean and dry. (Remove dressings carefully to avoid skin abrasions). You may not get the incision wet until the staples are removed; therefore, you must sponge bath. You may shower 2 days after the staples are removed, but may not bathe or swim until 2 weeks from the surgery date. You may apply Vitamin E or moisturising lotion to the incision after the staples are removed. Some swelling and warmth is expected after surgery. If you develop increased redness, drainage, or fever, call the office.

Bruising

Bruising around the thigh/knee area is not uncommon. This is a result of the tourniquet used during the surgery. This may extend down the leg into the shin, ankle/heel area, and will resolve in 10 - 14 days.

Swelling

Swelling around the knee and down the leg and into the foot and ankle region is normal. Reducing the swelling as much as possible will improve comfort and mobility. The following will help you reduce the swelling:

• Ted stockings: White knee high stockings need to worn for 2 weeks following surgery, removing them at bed-time, and putting them on prior to getting out of bed. The Ted stockings are available from the hospital on admission.
• For the first few nights when you go to bed, elevate your leg on 2 - 3 pillows (so that the knee is above the level of your heart). Also 3 or 4 times during the day, lay flat on your back with your leg above the level of your heart (on 2 - 3 pillows), for 30 minutes.

Ice Therapy

Ice is very important to help with pain and swelling. When you wake up in Recovery, you will have a specially designed ice pack, called a Cryocuf. At home ice needs to be applied consistently for the first 24 hours. Refreshing it every 2 - 3 hours. After the first 24 hours, apply a fresh ice pack on the knee, 3 - 4 times a day for 20 minutes on 20 minutes off. The ice and elevation may be helpful for up to 2 weeks after surgery. Swelling should be at its maximum by the end of the first week post-operation. If you feel the swelling is excessive, please call the office.

Walking

You will be out of bed walking within 2 - 3 hours after surgery. Upon discharge from the hospital you will be walking with crutches, and have a knee brace in situ. Discontinue wearing the brace on the second day after surgery, i.e. 48 hours after surgery. Generally, walking and bending is good, pain and discomfort will limit your activities. You may discontinue using the crutches when you feel comfortable, on an average within a week. After that you may use a cane if required. You may go up and down stairs as needed, but only straight legged for the first 2 weeks. After 2 weeks enough flexibility should be established to bend the knee while going up and down the stairs.

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