Shoulder Surgery: Essential Pre-Operative Instructions and Preparations

What are the instructions before shoulder surgery?

Before shoulder surgery, a comprehensive set of instructions will be provided by your medical team to optimize your physical condition, minimize risks, and ensure a smooth recovery. These instructions typically cover medical assessments, medication adjustments, lifestyle modifications, and logistical preparations.

The Critical Role of Pre-Operative Preparation

Undergoing shoulder surgery, whether for rotator cuff repair, labral tear, instability, or joint replacement, requires meticulous preparation. The period leading up to your surgery, often referred to as the pre-operative or pre-hab phase, is crucial for enhancing surgical outcomes, reducing potential complications, and expediting your post-operative rehabilitation. Adhering strictly to your surgeon and medical team's instructions is paramount.

Medical Consultations and Assessments

Your journey begins with thorough medical evaluations to ensure you are a suitable candidate for surgery and to identify any potential risks.

• Surgeon Consultation: This is where your surgeon will explain the specific procedure, its benefits, risks, and expected recovery timeline. This is your opportunity to ask any questions regarding the surgery itself.
• Anesthesiologist Consultation: You will typically meet with an anesthesiologist to discuss your medical history, any allergies, previous reactions to anesthesia, and the type of anesthesia planned for your surgery (e.g., general anesthesia, regional nerve block).
• Medical History Review: Provide a complete and accurate medical history, including all past surgeries, chronic conditions (e.g., diabetes, heart disease, high blood pressure, asthma), and any recent illnesses.
• Medication Review: Bring a comprehensive list of all medications you are currently taking, including prescription drugs, over-the-counter medications, herbal supplements, vitamins, and recreational drugs.
• Pre-operative Tests: You may undergo various tests to assess your overall health, which could include:
  • Blood tests: To check blood count, kidney and liver function, and clotting ability.
  • Electrocardiogram (ECG/EKG): To assess heart function.
  • Chest X-ray: To check lung health.
  • Urinalysis: To rule out infection.

Medication and Supplement Management

Managing your medications and supplements is one of the most critical aspects of pre-operative care to prevent bleeding complications and interactions with anesthesia.

• Blood Thinners: You will almost certainly be instructed to stop taking blood-thinning medications several days to weeks before surgery. This includes:
  • Aspirin and NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Such as ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex).
  • Prescription Anticoagulants: Such as warfarin (Coumadin), rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradaxa), clopidogrel (Plavix).
  • Always consult your prescribing doctor before stopping any blood thinners.
• Herbal Supplements and Vitamins: Many herbal supplements (e.g., ginkgo biloba, ginseng, St. John's wort, garlic, fish oil, Vitamin E) can affect blood clotting or interact with anesthesia. You will likely be advised to stop these 1-2 weeks prior to surgery.
• Diabetes Medications: If you have diabetes, your medication regimen (insulin or oral medications) will need to be adjusted or temporarily halted on the day of surgery. Strict instructions will be provided.
• Other Chronic Medications: Discuss all other chronic medications with your medical team. Some may need to be taken with a small sip of water on the morning of surgery, while others may need to be held.

Lifestyle Modifications for Optimal Healing

Certain lifestyle adjustments can significantly impact your recovery and reduce surgical risks.

• Smoking Cessation: If you smoke, you will be strongly advised to stop several weeks before surgery. Smoking severely impairs circulation, reduces oxygen delivery to tissues, and significantly increases the risk of complications such as poor wound healing, infection, and anesthesia-related issues.
• Alcohol Reduction/Cessation: Reduce or eliminate alcohol consumption, especially in the weeks leading up to surgery, as it can interfere with anesthesia and medication, and impact your body's ability to heal.
• Nutrition: Focus on a balanced, nutrient-rich diet to support your immune system and promote healing. Ensure adequate protein intake. Avoid excessive processed foods, sugar, and unhealthy fats.
• Hydration: Maintain good hydration in the days leading up to surgery, but adhere strictly to fluid restrictions on the day before and day of surgery.
• Weight Management: If you are significantly overweight, your surgeon may recommend losing weight prior to surgery to reduce stress on your joints and minimize surgical risks.

Pre-habilitation: Strengthening for Recovery

Pre-habilitation, or "pre-hab," involves exercises and physical therapy before surgery to improve your strength, flexibility, and overall physical condition.

• Goals of Pre-hab:
  • Improve existing range of motion and strength in the shoulder and surrounding muscles (e.g., scapular stabilizers, core).
  • Enhance overall cardiovascular fitness.
  • Educate you on post-operative exercises and precautions, making the transition to post-op rehab smoother.
  • Potentially reduce post-operative pain and improve functional outcomes.
• Physical Therapy: Your surgeon may refer you to a physical therapist for a tailored pre-hab program. These exercises will be gentle and aimed at maintaining function without exacerbating pain.
• Pain Management: Work with your medical team to manage any pre-existing pain effectively, ensuring you are as comfortable as possible before the procedure.

Logistical and Home Preparations

Planning ahead for the practical aspects of surgery day and your initial recovery period is essential.

• Fasting Instructions: You will receive specific instructions on when to stop eating and drinking before surgery. Typically, this is 6-8 hours for food and 2-4 hours for clear liquids, but always follow your specific hospital's guidelines.
• Hygiene: You may be asked to shower with a special antiseptic soap (e.g., chlorhexidine) the night before and/or the morning of surgery to reduce the risk of infection.
• Clothing: Wear loose, comfortable clothing on the day of surgery. Avoid jewelry, makeup, and nail polish.
• Transportation: Arrange for a responsible adult to drive you home after surgery, as you will not be permitted to drive due to the effects of anesthesia.
• Support System: Identify family or friends who can assist you in the immediate post-operative period, especially with daily tasks, meal preparation, and personal care.
• Home Modifications:
  • Clear pathways: Remove tripping hazards.
  • Accessibility: Arrange essential items at easily reachable heights.
  • Sleeping arrangements: Consider a recliner or elevated pillows if sleeping flat is uncomfortable.
  • Loose-fitting clothing: Have button-down shirts or loose tops ready, as dressing can be challenging.
  • Ice packs: Stock up on ice packs for post-operative swelling.
  • Easy-to-prepare meals: Plan for meals that require minimal effort.

Mental and Emotional Readiness

Preparing mentally and emotionally can significantly impact your surgical experience and recovery.

• Understand the Procedure: Ensure you fully comprehend what the surgery entails, the expected recovery timeline, and potential challenges.
• Ask Questions: Do not hesitate to ask your surgeon, nurses, or physical therapist any questions or voice any concerns you have.
• Manage Anxiety: Utilize relaxation techniques, mindfulness, or discuss your anxieties with your healthcare provider. Being well-informed can alleviate much of the stress.

The Day Before and Day of Surgery

• Confirm: Reconfirm your arrival time and any last-minute instructions with the hospital or surgical center.
• Pack: Pack a small bag with essentials like identification, insurance cards, comfortable clothing for discharge, and any necessary personal items.
• Follow Fasting Rules: Adhere strictly to the fasting instructions for food and drink.
• Medications: Take only the medications instructed by your medical team with a small sip of water.
• Arrival: Arrive at the hospital or surgical center at the designated time, accompanied by your support person.

Important Considerations

Remember that these are general guidelines. Your specific pre-operative instructions will be provided by your surgical team and may vary based on the type of shoulder surgery, your individual health status, and the hospital's protocols. Always prioritize and strictly adhere to the advice given by your healthcare providers. Open communication with your medical team is key to a successful surgery and recovery.