The Day Before Surgery
The day before surgery, you will receive a call with instructions about when to arrive and where to check in at the hospital. When you arrive on the day of surgery, plan to change into a hospital gown. Your belongings will be collected and a nurse will review important details such as your medications, allergies, and current pain level to help keep you safe and comfortable, so make sure you are ready to provide that information.
Prescriptions for your postoperative medications will be sent to your pharmacy the day prior to surgery. We recommend picking up these medications before your procedure so they are available when you return home.
The Day of Surgery
Once you’re settled in, an anesthesiologist will meet with you to review your medical history, discuss your anesthesia options (such as spinal, general, or regional anesthesia), and answer questions about what to expect during and after surgery. An IV will be placed so you can receive fluids and medications, including medicine to help with pain during your procedure.
Before You Go to the Operating Room
Before you go back to the operating room, I or a physician assistant on my team will review and sign the surgical consent with you and answer any last‑minute questions. Multiple members of the team will confirm your identity, which procedure is being done, and which side we are operating on. This repetition can feel confusing, but it is an important safety step to make sure every detail is correct.
Once everything is confirmed, the operating room staff will bring you into the operating room. The OR can feel cool, but you will be given warm blankets, and we’ll perform a brief time out so the entire team can again review your procedure, your allergies, and the correct side. At that point, your anesthesiologist will give medications to help you relax or go fully to sleep, depending on the type of anesthesia chosen, and will stay with you throughout surgery to monitor your vital signs and keep you safe.
Anesthesia Options
Your anesthesiologist will talk with you directly before surgery to recommend the safest option for you and to make sure you are comfortable with the plan. At the Hospital for Special Surgery (HSS), techniques such as spinal or nerve blocks are commonly used for orthopedic surgery because they offer excellent pain control and often allow you to wake up more quickly and comfortably than with general anesthesia alone.
Spinal Anesthesia
Spinal anesthesia is one of the most common forms of anesthesia for orthopedic procedures at HSS. Similar to an epidural used during childbirth, medicine is injected into the spine to numb your body from the waist down. You typically receive light sedation at the same time, so you breathe on your own but are not aware of what is happening in the operating room. Many patients wake up more easily and quickly after spinal anesthesia compared with general anesthesia.
General Anesthesia
General anesthesia affects your entire body and brain, so you are completely asleep with no awareness of the surgery. It may be given through an IV, through a mask, or both, and a breathing tube or mask keeps your airway protected during the procedure. You will not feel anything or remember the surgery, and it is normal to have a mild sore throat afterward from the breathing tube.
Regional (Nerve Block) Anesthesia
Regional anesthesia involves injecting numbing medicine near specific nerves. For example, an injection around the neck or shoulder for shoulder surgery or near the thigh for knee surgery to block pain signals before they reach the brain. These blocks are usually combined with light sedation or general anesthesia so you remain comfortable throughout the procedure.
To place the block, you lie down while the anesthesiologist numbs the skin and then injects medicine near the nerve, often using ultrasound guidance. The block may last 6–8 hours or sometimes longer, providing significant pain relief after surgery. It is important to start your postoperative pain medicine as soon as you begin to feel discomfort or when the numbness starts to wear off, so you stay ahead of the pain.
After Surgery: Recovery Room
After your surgery is complete, you will be taken to the recovery area (also called the Post-Anesthesia Care Unit or PACU). Nurses and anesthesia staff will closely monitor your breathing, heart rate, blood pressure, and comfort as you wake up from anesthesia.
It is normal to feel sleepy, groggy, or slightly disoriented at first. Some patients may experience mild nausea or chills as the anesthesia wears off, which can be treated with medication if needed.
Your surgical team will update your family or support person once the procedure is finished.
Pain Control After Surgery
Your care team will use a combination of medications and techniques to keep you comfortable after surgery. This may include nerve blocks, anti-inflammatory medications, acetaminophen, and sometimes stronger pain medications if needed.
If you received a nerve block, the surgical area may remain numb for several hours after surgery. As the numbness begins to wear off, it is important to start your prescribed pain medication as directed so that pain does not suddenly increase.
Our goal is to keep your pain manageable so you can begin moving safely and start your recovery.
Going Home
Many orthopedic procedures are performed on an outpatient basis, meaning you will go home the same day once you are fully awake, comfortable, and medically stable.
Before leaving, your care team will review:
- Your medications
- Wound care instructions
- Activity restrictions
- When to begin physical therapy (if applicable)
- Signs of complications to watch for
You must have a responsible adult available to take you home after surgery.
When to Call or Seek Help
Please contact my office or seek urgent medical care if you notice any of the following after surgery:
- Fever or chills that do not improve.
- Increasing redness, warmth, drainage, or a bad smell from your incision.
- Sudden or significantly worsening calf pain, swelling, or tenderness.
- Chest pain, trouble breathing, or sudden shortness of breath.
- Severe pain that is not improving with the prescribed plan.
- New numbness, weakness, or other neurologic symptoms that concern you.
If you are ever unsure whether a symptom is expected, it is always better to call and ask so we can help you decide on the safest next step.
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