What you need to know before your surgery
When should I arrive in hospital?
Typically, you should arrive on the morning of the surgery at a time and ward designated by the hospital. I will meet you on the ward prior to the surgery to mark the arm which is to be operated, to confirm consent for the operation with you, and to answer any further questions you might have regarding the surgery
Should I take my normal medications?
In general, you should take all of your usual medications, with a small sip of water, on the morning of surgery unless specifically instructed otherwise.
Should I remove my wedding ring?
Yes, if it is attached to the arm that the surgery is taking place on. This is because your arm can swell during and after the surgery which may cause the ring to dig in around the base of your finger, causing pain and restriction of blood supply to the fingertip.
“Nil by mouth”:
Leading up to an anaesthetic it is important not to eat or drink anything for at least 6 hours before. This helps prevent potentially life-threatening problems caused by regurgitation and inhalation of stomach contents during the anaesthetic. Therefore, most patients are asked to be “nil by mouth” from midnight of the day of surgery. Clear fluids such as water and black tea may be allowed up until 2 hours before the anaesthetic, but this needs to be clarified with the treating anaesthetist when you meet them on the morning of surgery. Those patients who are scheduled toward the end of a list are told a time up to which they can consume clear fluids and may occasionally be allowed to eat up until a certain time.
List order: Occasionally, the order of an operating list may need to be changed on the day of surgery for a number of reasons that are usually not foreseeable – it is best to clarify this with me when you meet me on the morning of surgery.
Anaesthetic: Patients that undergo hand and wrist surgery can have it done under a local anaesthetic injection into the area being treated, can have a general anaesthetic or a regional nerve block, in which the anaethetist numbs the whole arm with an injection. Which of these is appropriate depends on the nature of the operation being performed, and is something I would discuss with you when talking about your operation during our outpatient consultation.
Nerve blocks: Nerve blocks provide excellent pain relief for the first 24-48 hours after surgery, which is usually the most painful time. They are given by the anaesthetist. The nerve block involves an injection of local anaesthetic into your neck or upper arm on the side of the surgery, usually guided by ultrasound, aiming to “block” the nerves that supply pain fibres to the arm and hand. A good “block” will result in total or near total numbness. Temporary paralysis of the arm will also occur. It is therefore very important to wear a sling to support the arm whilst the block is working, since a paralysed and numb arm can easily be damaged inadvertently by knocking into things without realising. A sling will be in place by the time you come round from the anaesthetic, which is necessary to control your arm whilst it is under the block.
Side effects of the nerve block: Occasionally the block can also temporarily affect nerves supplying other areas, such as the diaphragm (causing shortness of breath), face (causing a droopy eyelid) or vocal cords (causing a hoarse voice). Further discussion regarding the benefits, risks and complications of nerve blocks can be had with the anaesthetist who will see you prior to the surgery.
What happens after the surgery?
At hospital: You will wake up in the theatre recovery room and once you have come round from the anaesthetic, which usually takes about 15 mins, you will be transferred back to the ward. You may eat and drink as you feel able once back on the ward. I will visit you on the ward shortly after the surgery to explain my findings and any changes to the aftercare plan based on the procedure that was actually carried out (sometimes decisions on the type of surgery carried out have to be made during the operation itself, although the various possible options possible will be discussed beforehand during the consent process).
Following hand surgery it is important to keep the hand elevated and to keep the fingers moving. For soft tissue procedures such as carpal tunnel release, trigger finger release or ganglion excision the bulky bandages can be removed after forty-eight hours. The wounds should be kept covered with a dressing and dry until you are seen for a follow up appointment at about two weeks. At this stage any sutures will be removed. Following removal of sutures the scars can be a bit lumpy and tender. This will benefit from being regularly massaged with a moisturising cream such as E45.
The patients having surgery for Dupuytren’s disease or other joint release procedures of the fingers then at the end of the operation a plaster of paris slab is applied to the front of the hand. You will then be booked in to see a Hand Therapist a few days after the surgery who will make a removable thermoplastic splint which we would normally ask you to wear at night for the first three months following the surgery. Again there will be stitches which we will remove at about two weeks.
Following some hand procedures such as trapeziectomy or fixation of fractures the hand or wrist are immobilised in a plaster of paris cast. This is initially a slab of plaster of paris held on with bandages. At two weeks this is removed so that the sutures can be removed and a complete fibre glass cast is applied at this point. When the hand is in a cast it is important to keep it elevated and to keep the fingers moving. It has to be kept dry. If the cast becomes too tight or too loose, gets wet or is uncomfortable then it may need to be changed. If you are planning to fly with your hand or wrist in a plaster cast then you will need to discuss this with me as airlines will often not let people fly if they have a recently applied full cast but by ‘splitting the cast’ we can get round this issue.
Driving: Following most hand surgery I am happy for my patients to drive as soon as they feel safe to do so. For procedures such as carpal tunnel syndrome this may be within a few days of the surgery but for more major surgery and certainly if the hand is in a cast then this will be rather longer. I think it is advisable to notify your insurance company that you have had surgery on your hand prior to starting driving.
Time off work: Typical times before return to work for the following procedures are advised, although may be altered according to individual circumstance. Return to work also depends on whether you have a manual or desk based job, and also whether you would be allowed back on light duties/phased return (if manual).