Post-Operative Spine Care

Transcription

1 Pst-Operative Spine Care Activity: Yu will need t avid bending, lifting, twisting, and sudden mvements fr three weeks after surgery Sitting, specially if leaning frward, results in the greatest frces being transmitted thrugh yur lumbar spine. Hence, avid prlnged sitting fr at least three weeks after surgery. On the first pst perative day yu shuld nly sit fr meals. Ensure yu stand r lie dwn fr 5 minutes, after yu have been sitting fr 10 minutes. This advice is applicable t everyne with back cnditins but is particularly imprtant in the early pst-perative perid. Walking is the simplest and safest exercise prgramme which starts n the first day after the peratin. Yu shuld be able t take 6-8 shrt walks befre discharge hme. This will help yu strengthen yur muscles, imprve yur cnfidence, imprve yur breathing and prevent clts in the legs. Gradually increase yur walking distance utdrs every day. Yu shuld feel cnfident that yu are ging t be able t cmfrtably attend t yur activities f daily living befre being discharged hme. If yu d nt feel cmfrtable abut this issue please raise yur cncerns with me r my team dctrs and nurses. Yu shuld nt g hme until yu can manage yur rutine day t day activities safely at hme. Physitherapy: In the hspital, yur physitherapist may use treatments t help settle sreness and muscle spasm. The therapist will teach yu hw t transfer frm lying t sitting and standing safely. They will help yu with yur cnfidence when walking and teach yu general safe techniques fr yur back. This educatin shuld cntinue later n after discharge. After the sixth week fllwing surgery yu will mve nt mre active physical treatments t build up yur strength and imprve yur flexibility. This may include endurance exercises such as treadmill walking and static cycling further help muscle strengthening. It's imprtant t

2 achieve gd muscle cntrl f mvements befre yu try and push yur range f mvements t far. Make sure yu are happy with ne stage in yur prgramme befre yu try and mve nt the next. As yu gain cnfidence in yur mvements yu can incrprate these in everyday tasks and activities. It is imprtant t nte that truncal and paraspinal muscle strengthening, range f mvement exercises and therapies fr muscle spasm, fllwing surgery at an apprpriate time frame, can reduce the risk f develping chrnic wer back pain withut increasing the risk f recurrent symptms, fr example frm recurrent disc herniatin. Yu are encuraged t cmmence hydrtherapy a few weeks after surgery. Simple and safe water based exercises help imprve range f mvement and cmfrt. It will als help yu recnditin yur muscles whilst aviding stresses n yur back as the weights transmitted thrugh yur spine will be reduced in the water. Befre entering the pl area make sure that yu have adequate balance t avid falls and ensure that yu take necessary safety precautins t avid slipping. Water based exercises are f great value t yur recvery. But remember that yu are respnsible fr yur safety in the pl area. Diet: ensure a balanced diet with adequate intake f prteins, carbhydrates, and fats. Make sure yu cnsume a diet rich in calcium. Drink plenty f milk and increase yur intake f dairy prducts. Pain killers used after Spine Surgery: Pain fllwing spine surgery is ften cnfined t the area f surgery and is ften nt severe. Severe pain, specially in the limbs warrants further investigatin. It is desirable t reduce yur pain-killers t a single simple agent, preferably Paracetaml and t cease this gradually as yur cnditin imprves. The fllwing is a list and brief descriptin f sme f the medicatins used fr the treatment f spinal pain: Paracetaml is an effective and simple medicatin with few side effects if taken in crrect quantities. Dsage: 1 g every 6 hurs as required.

3 Panadeine Frte: cntains Cdeine as well as paracetaml and helps with mre severe pain. The Cdeine cmpnent is an piate and will cause dependency if taken ver lng perids f time. It can cause nausea, headache, irritability, pr cncentratin and cnstipatin. Digesic: This is similar t panadeine frte. It is a strnger pain killer than paracetaml. It cntains Paracetaml and Dextrprpxyphene.. IT can cause dependency and has sme side effects including nausea, headache, drwsiness, irritability. Dsage: 2 tablets every 6 hurs (Maximum 8 tablets per day) Tramadl: Als used fr mderately severe pain. It is a synthetic piate. It has the ptential fr serius interactins with ther medicatins especially antidepressants. Yu shuld discuss its use with yur dctr. It shuld nt be used if yu have had seizures r brain surgery. Dsage depends n yur cnditin and histry f previus use f Tramadl. Nn-steridal anti-inflammatry medicatins: Ibuprfen (Brufen, Rafen, Nurfen ), Indmethacin (Indcid ), Pirxicam (Mbic ) and Mefenamic Acid (Pnstan ). They can cause kidney prblems and peptic ulceratin, perfratin f peptic ulcers and bleeding ulcers They may interfere with nrmal bldd cltting They shuld be taken after a meal If yu have had a spinal fusin r brain surgery r any ther brain cnditins yu shuld use this grup f medicatins nly after discussin with me. If yu have a histry f kidney prblems r peptic ulcer disease yu shuld avid these medicatins They can interact with ther bld thinning medicatins such as Aspirin r Warfarin If yu get pain in tummy pains, r vmit brwn cffee-grund material, r have bldy r black stls yu shuld discntinue medicatins frmthis list Drug Interactins with bld thinning medicatins (eg Warfarin) and bld pressure lwering medicatins*

4 Mrphine, Oxycdne (Endne and Oxycntin SR ) These medicines shuld nly be taken when required r as directed fr mderate t severe pain. Mrphine can be given thrugh a drip r as an injectin under the skin. Endne is an immediate-release mrphine-like tablet which can be taken up t every three hurs. The dse is usually mg (½ -2 tablets) Oxycntin is a sustained-release mrphine- like tablet which means that the tablet gradually releases the drug int yur bdy. The dse, which must be swallwed whle, is usually mg twice daily taken regularly (every 12 hurs). It is imprtant t remember that Oxycdne may cause an additive effect with sedatives and/r alchl*. We need t knw if yu usually take any ther strng (piid) pain killers such as Mrphine* Als advise yur dctr if yu have had seizures (fits) r a head injury. All piids can cause side effects including nausea, dizziness, headache, cnfusin, drwsiness and skin rash. Let yur dctr knw shuld yu experience any f these symptms. Cnstipatin is cmmn and yu may be prescribed laxatives t lessen this side effect. Nerve Stabilising Agents Endep (Amitriptyline); an antidepressant at higher dses, is taken at 10 mg at night time t help with neurpathic pain. Lyrica (Pregabalin): used fr the treatment f sme frms f seizure and neurpathic pain Neurntin (Gabapentin):Originally develped fr the treatment f epilepsy. It is ften used fr the treatment f neurpathic pain Sterids: Dexamethasne is the mst cmmn sterid used fr the treatment f neursurgical cnditins In spine surgery shrt curses are smetimes prescribed fr the treatment r preventin f nerve rt r spinal crd swelling. Prlnged use shuld be avided as it can cause suppressin f the immune system, reduced bne density and strength, md swings/changes, increased appetite, weight gain, disprprtinate gain f fat arund the trunk, easy bruising and bleeding, diabetes mellitus and interference with cntrl f bld sugar levels if diabetic. Tramadl Tramadl may be prescribed fr mderate t severe pain. The nrmal dse is mg up t fur times daily (less in patients wh are elderly r have kidney disease). Wund care: The wund is usually clsed using disslving sutures and shuld nt be saked under water fr the first week after surgery. Patients usually shwer with a dressing and change it fr a dry ne afterwards. The wund shuld nt be saked uncvered fr the first three weeks. Sme pain shuld be expected within the first week after surgery which is mild and cnfined t the area f surgery. This will imprve after a few days.

5 If the pain returns and is severe, r if pins and needles dn t settle, patients shuld cntact the ffice. Similarly, yu shuld seek medical advice if yu get discharge frm yur wund r any fever. Driving: As a general rule yu shuld avid driving fr at least tw weeks after surgery. Driving is safe if yu are cmfrtable and safe and able t perfrm all f the required functins withut impairment. Sme specific cnditins include: Being alert and riented and under influence f n medicatins that can affect yur cgnitive functin Being able t cmfrtably lk back t check yur blind spt Having nrmal muscle pwer in yur legs, ankles and feet and t use the car s pedals with nrmal crdinatin and strength Wrk: Exactly when yu start wrk will depend n yur cnditin and yur ccupatin. Yu shuld avid wrk in general fr a perid f three weeks after surgery. Further restrictins apply if yur jb invlves prlnged sitting r physical wrk such as bending r lifting. Fllw-up Yur sutures are disslvable. Hwever, we recmmend yu t bk an appintment t see yur general practitiner at ne week fllwing discharge frm the hspital. This gives yu and yur GP an pprtunity t review yur general health, medicatins and yur surgical wund. Yur GP will be updated n yur prgress as he/she receives yur discharge summary frm my practice. Hwever, please take yur discharge summary with yu in case there are delays in the mail reaching their practice. Yu shuld see me between 4 t 6 weeks fllwing yur peratin. Emergency Review: Yu shuld ntify yur dctr r attend the emergency department at St Gerge Public Hspital if yu develp any f the fllwing symptms after discharge. Yu are requested t cntact my ffice and ntify me if this happens: Any frm f pain that is new, wrsened wund pain r pre-existing pain,

6 any pain that is difficult t manage fr yu Fever (a sign f infectin r deep vein thrmbus) Wund redness, wrsened wund pain r swelling, r any discharge frm yur wund (signs f infectin) Pain in the legs, in particular in the calf regin r behind the knee (which may be a sign f a clt in the leg) Any new r wrsened numbness, weakness, pins and needles sensatin Any difficulty with the cntrl f bwel and bladder functin Chest pain, shrtness f breath, r ther cncerning symptm