Preoperative Pain Control Considerations
You will have pain after surgery and that must be expected. Pain varies and depends upon the individual patient as well as the surgical procedure performed. Pain medication should be used as needed and specific instructions will be provided. Narcotic prescriptions may be given to you prior to surgery. They must be filled within a week of the day written, otherwise the pharmacy will not fill them. However, you must not use or lose them prior to surgery and that is your responsibility. Filling the prescription prior to surgery will eliminate stopping and delays on the way home from surgery. Usually they are given at the time of surgery and can be filled on the way home. Remember to ask for NON childproof caps if there is no one to open them for you. However, they must be kept in a safe place away from children. If you have specific preferences or problems, please inform us. Remember you should not drive for 24 hours after anesthesia that includes any sedation. Also you canot drive while taking narcotics or judgment altering medications. (See Living with an Injured Hand)
Postoperative pain control can start preoperatively. Preoperatively a medication such as Celebrex (Cox 2) 400 mg/day or similar non-steroidal anti-inflammatory (NSAI) medication (may not be covered by insurance) may be used starting either the day before or the morning of surgery with a sip of water. Tylenol 1000 mg (if you do not have liver problems and it is allowed by your primary care physician) four times a day starting the day prior to surgery and including the morning of surgery may help postoperative pain. (Maximum dose of Tylenol is 3000 mg/day including all sources (percocet, Tylenol with codeine and other medications also contain Tylenol). The effect of taking Celebrex (or other anti-inflammatory) and Tylenol seem to be additive (synergistic). Celebrex or other anti-inflammatory is usually continued postoperatively for 2-5 days until the pain is controlled. It may be stopped as soon as the pain is under control. Other anti-inflammatory medications or aspirin should not be taken at the same time unless it is allowed by your primary care physician. If Celebrex is not covered by your insurance or you do not have a prescription for an anti-inflammatory an over the counter (OTC) anti-inflammatory (NSAI) such naproxen or ibuprofen can be used if you are normally allowed to take these medications. Naproxen (Aleve, Anaprox, Naprosyn etc) approximately 500-550 mg two times a day with food is recommended. Alternatively ibuprofen (Advil,Nuprin, Motrin etc) 600 mg to 800 mg 3-4 times per day (maximum dose 3200 mg/day) with food. If gastrointestinal (GI) symptoms arise please discontinue the anti-imflammatory medications. Naproxen, ibuprofen or other non-Cox 2 anti-inflammatory medictions can not be taken for 5-7 days prior to surgery. Also NSAI medications may interfere with bone healing. Therefore they should be limited if bone healing is neceassry for your recovery. This includes fracture healing, healing of fusions or bone ingrowth for prosthesis. If questions arise please check with the office.