Typically, surgical procedures performed in association with Kienbock’s Disease are performed on an outpatient basis (aka, ambulatory surgery, day surgery), so after a period of recovery you will go home. The recovery room staff is there to help you regain your senses and, most importantly, get control of your pain. Do not feel hurried and do not leave until you feel comfortable. It’s hard to describe, but you will know when it’s time.

Following surgery with general anesthesia, you will hurt and possibly feel nauseated. Your doctor will leave orders for the pain medications he wants you to have, or he may leave this to the anesthesiologist (who ultimately oversees your recovery). It is not unusual to require more than a few doses of one or more medications to get relief. After each administration, you will be asked to rate your pain (scale of 1 to 10). Don’t be shy with your rating, no one can address your pain appropriately unless you tell them. If you are nauseated, make it known, you can receive something for that as well.

If you have had regional anesthesia, your arm will have no feeling for approximately 8 hours (can vary 6 to 10 hours or even longer), the hurt doesn’t start until the block wears off. You will have received sedatives, so you will still require some time in the recovery room. The “dead” arm must be handled with care since it will have no feeling.

When you are ready to leave the hospital, you will receive discharge instructions and a prescription for narcotic pain medications and possibly antibiotics (some prefer IV antibiotics, and/or a combination of the two). Have the prescription(s) filled immediately. Take it as prescribed (usually a dose every 4 hours) for at least the first few days, even if you don't feel like you need it. If you have had regional anesthesia, start taking the pain medication before the block wears off. You will get the best pain control if you stay "in front" of the pain, so don't wait until you hurt. If you wake at night, go ahead and take one.

Your pain is unique to you, do not compare yourself to anyone in this regard. Take your medication as long as you feel you need it. It may be a week or 8 weeks (or longer), there is no schedule to adhere to other than your personal needs. You might find the prescribed medication excessive or ineffective, in either case call your doctor and he can prescribe something else.

Narcotics are very safe and effective pain relievers. Unfortunately, there are some side effects, most notably, stomach upset and constipation. Eat something with each dose, something with a little substance, not just a saltine or two. Get an over the counter product like Fiber Con and take as directed. Additionally, drink lots of water. The water will help with the constipation and also helps to flush out all the drugs and gases that are used during surgery. Keep a big cup with a straw nearby, sip water all day.

Swelling is a post op issue that only adds to the discomfort of surgery. Once it starts it can be hard to reduce, so better to get in front of it as well. You can alternate the pain medication with a NSAID (like ibuprofen). Keep your arm elevated above your heart 24/7 (and that means while sleeping too). Do whatever you need to keep the arm up: sleeping in a recliner, propping with pillows. Or you might receive a big foam block (removable) that can encase your arm and is excellent in keeping your arm upright, even while sleeping.

Immobilization of an extremity brings circulation to a crawl, venous blood will not drain quite as quickly and thus painful swelling can occur. Elevation helps but gently moving your fingers will also aid in keeping the blood moving. If necessary, use your other hand to move the fingers, do not use force, just gentle movement (unless, of course, this is for some reason forbidden by your doctor).

Be kind to yourself, take care of your pain, after all, you wouldn’t inflict that feeling on anyone else, would you? Rest well and heal well.

Temporis ars medicina fere est.
Contributed by Phyllis Walker

IMPORTANT:
In the July 2002 Orthopedics Today, it was reported that Cox-2 inhibitors and, to a lesser extent, NSAIDs may interfere with bone healing in animal studies. While this has yet to be proven in humans, Thomas A. Einhorn, MD, of Boston University Medical Center, suggested, “Based on our current understanding, it would seem that a prudent approach toward the management of patients is to temporarily avoid or discontinue the use of both NSAIDs and coxibs during a period of bone healing.” Coxibs (Cox-2 inhibitors) include Celebrex. NSAIDs include ibuprofen (Advil), naproxyn (Aleve), and many of the non-narcotic prescription pain medications. Speak to your doctor about this matter as it relates to your post-operative pain management.