Dr Geoffrey Smith

DISCHARGE TIME
If you have stayed overnight, discharge time is 10am.

PHYSIOTHERAPIST
You will usually be seen by a physiotherapist prior to discharge. Exercises will be demonstrated to you and written information supplied.

PHARMACY
On the way out of the hospital please go to the pharmacy

1. Buy the following over the counter:
   
   • Paracetamol 500mg 100 TABS
     
   • Ibuprofen 200mg 30 TABS
     
   • Vitamin C 1000mg 14 DAY SUPPLY
     
   • Vitamin D 800 IU 3 MONTH SUPPLY (if you had rotator cuff repair)
2. You will also have received a prescription for Tapentadol

Local Anaesthetic (LA) and blocks
LA will be injected around the incision(s) at the end of the procedure. A nerve ‘block’ may also have been used at the start of the procedure. These will provide good pain relief for 6-24 hrs. If you have had a ‘block’ you may also have a numb, tingly or floppy arm. This can last up to 24 hours.

Ice
Ice after surgery is a very effective pain-relieving option that is free from side-effects. While you are awake, ice the site of surgery for about 20 mins every 1 to 2 hours. Even if you aren’t having a lot of pain, this is a good idea for the first 2-3 days. Options for icing include a bag of ice, a bag of peas, or a dedicated ice/ compression machine.

Exercise
Gentle exercise is a good form of pain relief. You will be shown simple and safe exercises prior to discharge Do not push through the pain barrier. Do not force or stretch. Only do what you are shown. Doing more now does not improve your outcome later.

Vitamin C
Vitamin C can decrease pain after surgery and may prevent nerve related pain developing.

Paracetamol (Panadol)
A simple and safe painkiller that can be used in combination with other stronger medications. Paracetamol decreases the number of stronger painkillers that are needed.

Do not stop taking paracetamol just because it does not take away all your pain.

Non-Steroidal Anti-Inflammatories - NSAIDs (Ibuprofen, Mobic, Celebrex)
These are effective painkillers that can be used in combination with other stronger medications. Anti-inflammatories decrease the number of stronger painkillers that are needed.

Do not stop taking anti-inflammatories just because they do not take away all your pain. NSAIDS modulate bone and soft tissue healing processes. So we try to use them at specific times only.

1. We recommend 3 days of anti-inflammatories to help with the immediate pain post-operatively (if this is safe for you; as per the operation note)
   
2. Then you should avoid NSAIDs from 3 days-6 weeks following surgery as they may interfere with healing
   
3. Then you should use NSAIDS (if safe and tolerated) from 6-12 weeks if you have had tendon repair surgery as they may improve tendon remodelling

Tapentadol
Is a strong painkiller that may cause some side effects and can be addictive. The dose of Tapentadol is variable depending on age, weight and other factors. They are supplied in 50mg tablets. Usually 50mg (one tablet) is sufficient. If pain is severe a second tablet can be used. We aim to decrease the dose and stop Tapentadol as soon as possible.

Vitamin D
Vitamin D is important to bone health and studies also suggest that Vitamin D deficiency can be associated with poor healing after rotator cuff repair. Many patients are Vitamin D deficient. I recommend that you take Vitamin D (800 IU) for a month prior and for at least 12 weeks following rotator cuff repair surgery.

SUMMARY OF TABLETS TO BE TAKEN AFTER SURGERY

PHASE 1: THE FIRST 3 DAYS AFTER SURGERY

1. 2 x 500mg Paracetamol regularly every 6 hours (4 times per day) Take Paracetamol whether you are in pain or not.
   
2. 2 x 200mg Ibuprofen regularly every 8 hours (3 times per day with food) Take Ibuprofen whether you are in pain or not.
   Only if safe for you. As per the operation note.
   
3. Tapentadol (Palexia) 1 OR 2 tablets (50-100mg) every 4-6 hours as needed Most patients require Tapentadol during this time.
   Aim to take as little Tapentadol as possible.
   
4. Vitamin C 1000mg once per day
   
5. Vitamin D 800 IU once per day if you have had a rotator cuff repair

PHASE 2: 3 DAYS TO AROUND 2 WEEKS AFTER SURGERY

1. 2x 500mg Paracetamol regularly every 6 hours whether you are in pain or not.
   
2. Tapentadol (Palexia) 1 OR 2 tablets (50-100mg) if needed.
   Most patients only need to take Tapentadol at night-time.
   Some patients need to continue Tapentadol occasionally during the daytime as well. Aim to stop Tapentadol as soon as possible.
   
3. Vitamin C 1000mg once per day. Stop after 2 weeks.
   
4. Vitamin D 800 IU once per day if you have had a rotator cuff repair.

PHASE 3: PAINKILLERS (AROUND 2 WEEKS AFTER SURGERY)

1. 2 x 500mg Paracetamol at night-time if needed.
   Most people need night-time painkillers for 4-6 weeks.
   Some patients need to continue Panadol during the daytime as well.
   
2. Vitamin D 800 IU once per day if you have had a rotator cuff repair. Stop after 3 months.

PHASE 4: TENDON REMODELLING PHASE (FROM 6 WEEKS TO 12 WEEKS AFTER SURGERY)

1. 2 x 200mg Ibuprofen regularly every 8 hours (3 times per day with food) if you have had a rotator cuff repair. Only if safe for you. As per the operation note.

This is particularly common after key-hole (arthroscopic) surgery. Your shoulder and elbow will be swollen from the fluid used to distend the joint. The retained fluid is absorbed over the first few days after surgery, but it is normal for some of this to leak out as a blood-stained fluid from the surgical scars. You will normally have a large absorbent dressing over the shoulder when you return from theatre. This will be removed before you are discharged, and the splash-proof dressing changed if needed. You will be given spare dressings to take home with you. The wounds should be kept clean and dry for two weeks when they will usually be checked in the clinic.

You will be able to shower, while attempting to keep the affected part of the arm out of the spray as much as possible. If the dressings do become wet, they will need to be changed as soon as possible. Your sling can be removed for showering and a disposable paper sling used instead. Alternatively, you can support the weight of the arm with the unaffected hand or letting the arm rest on your abdomen.

After any operation on the shoulder or arm swelling will occur. Ice therapy will help in the first 2 weeks.

If you have had elbow or wrist surgery, elevating the hand as much as possible will help whether you are standing sitting or lying down.

The bruising may go down to the elbow as well. This is temporary and resolves within a couple of weeks.

Expect this to be a bit difficult for the first few weeks. Some people find it easiest to sleep in a reclining chair while others sleep in their normal bed. A pillow wedge can be useful for sleeping in bed.

The sling may be removed for showering. OTHERWISE IT SHOULD BE WORN AT ALL OTHER TIMES UNTIL YOU ARE TOLD BY DR SMITH. Further information is available in your rehabilitation sheets.

If you do not already have an appointment made please ring the rooms and make a booking.