After Your Child’s Surgery

After Your Child’s Surgery
Your child has just undergone surgery, and we hope everything is going well. You may find some specific instructions for the operation your child had in this section of the website, and the following should be considered more “general” information. All operations are in many ways related (i.e. most children have general anesthesia for a procedure), so we encourage you to read this entire section very carefully before proceeding to more specific information that may be found nearby.

Contacting Us After Surgery
We understand that having a child undergo surgery can be a frightening prospect. In general, though, children heal incredibly well and with a surprising lack of discomfort. Although you will receive instructions for post-operative care at the office, at the surgical facility, and through this website, you may have unanticipated questions or concerns after discharge from the facility. Please make sure you cannot find the information you need by carefully reviewing this website. If you find that we have not included some critical information, please let us know so that we can assist other families in the future.

If you need to contact us with a question after surgery, please feel free to call the Lexington office at 859/275-KIDS (5437) or the Louisville office at 502/410-4700. If it is after hours or on the weekend, please first decide if it is something that can wait until the office opens. If you feel you must speak with someone immediately about your concern, please call the office and use the phone mail system.  Option 2 is for after hours patient emergencies.  By pressing this option, the cell phone of the on call provider will be called directly and immediately.  If you are asked to leave a message, please state your name, the patient’s name, the reason you are calling, and a contact phone number.  Please speak slowly and clearly, and repeat the information.  If  your child needs new or different medication, and if it cannot wait until the office opens, please leave the name of your pharmacy and your pharmacy’s phone number.

Pain Control/ Pain Medication

When we perform a procedure, we try to make your child as comfortable as possible after surgery. For major surgery, we frequently perform a local anesthetic and/or a regional anesthetic (i.e. caudal or tailbone injection) for pain control, as long as the anesthesiologist feels your child is a candidate for it. We also use patient-controlled anesthesia (PCA), delivered via an IV until the patient can take pain medication by mouth. Any child who is admitted to the hospital will be on oral pain medication by the time of discharge.

For minor (outpatient) surgery, we usually inject a local anesthetic to numb the area, or the anesthesiologist will inject an anesthetic in your child’s tailbone to “block” the pelvic region. Local anesthetics (numbing medicine) usually wear off after four to eight hours. As soon as you detect any evidence of discomfort after surgery, give your child a dose of the prescription oral pain medicine. It usually takes about 30 minutes for the pain medicine to take full effect. Within a couple of days, most children have good pain relief with plain Tylenol, or by alternating doses of the prescription pain medication with plain Tylenol. Remember, the pain medication may have Tylenol in it, so do not administer Tylenol-containing prescription pain medication and plain Tylenol simultaneously, as this may lead to an overdose of Tylenol. In general, we do not recommend the use of ibuprofen (Children’s Motrin) for 72 hours after surgery due to potential bleeding complications (ibuprofen is a blood thinner). After 72 hours, ibuprofen is safe and often more effective than Tylenol, but it should not be given to children less than 6 months of age.  It should only be taken with meals, and it should be discontinued if it causes stomach upset.

We try to discharge all our patients after surgery with an adequate prescription for narcotic pain medication based on our experience of what a child typically needs after a particular operation. VERY RARELY, a child will need a second prescription. If you perceive your child needs more pain medication, there may be complications brewing, so please inform us immediately. Monitor how much medication your child has and whether or not your child will run out before over-the-counter medications will be adequate. PLAN AHEAD. Do not call after hours for pain medication, as most pain medications cannot be “phoned in” to a pharmacy. You will need a written prescription. Also, because there might be a problem, we may not be willing to prescribe additional narcotics without seeing your child first. If you think your child needs more pain medication, call the office in the morning. On weekends, call first thing in the morning. Please review our pain medication policy outlined in the section entitled Medication Policy found within the “General Information” section of the website.

Other Medications
Your child may be prescribed other medications or treatments after surgery, particularly antibiotics and topical ointments. Please follow medication instructions carefully, as this will maximize your child’s chances of having a good outcome.

Fever or Rash
Fevers are not uncommon shortly after general anesthesia, and this is usually due to collapse of small air spaces in the lungs (atelectasis). The best therapy is to get your child out of bed and standing up or walking, taking deep breaths. Hospitalized patients may be prescribed a breathing device to help the lungs open back up. Tylenol should also help. Any fevers occurring more than 48 hours after surgery, or any fevers in excess of 103 degrees (or 39 degrees centigrade), should be reported to us immediately. If your child’s fever persists, or there seem to be any respiratory symptoms such as severe coughing, please let us know.

If your child develops a rash after surgery, he or she may be allergic to a medication used before, during, or after surgery. If this occurs, please discontinue all medications except plain Tylenol and call us.

Aches and Pains
Strange aches and pains are common after surgery, and they may be related to being in a strange position on the operating table for several hours. These sensations usually resolve over several days; if they persist, please let us know. Sometimes, nerves get compressed by the position of the patient while asleep. When this occurs, there may be a period of numbness or the sensation of pins and needles after surgery in the affected area; if this occurs, please let us know. While your child is asleep, his or her eyes will be taped closed so that the cornea does not dry out. If your child has any discomfort in his or her eyes after surgery, please let us know immediately.

Bruising, Swelling and Bleeding
With nearly any operation, one should expect some bruising, swelling, and oozing of blood. This is normal. Sometimes the swelling can be very impressive. As long as your child seems comfortable, this is usually normal. If there is considerable bruising and swelling, there may be a blood clot in the surgical site that needs to be evacuated. If this occurs, please contact us immediately. Any bleeding over and above mild oozing (i.e. the formation of clots in the diaper) should also be reported.

Incisions and Wound Care
The length of your child’s incision is largely determined by your child’s size and the amount of exposure needed to safely and correctly perform his or her operation. As a plastic surgeon, Dr. Schaeffer tries to make the incision as small and as concealed as possible. The wound may be closed with absorbable sutures (stitches), non-absorbing sutures (requiring later removal), staples, glue, or any combination of the above. Ultimately, the appearance of the wound will generally be the same irrespective of the method of closure. Contrary to popular opinion, staples do not hurt if they are removed properly. In some instances, staples are the preferred method of closure. In general, Dr. Schaeffer will choose the method of closure for your child’s incision that will lead to the best possible result, taking in to account all factors, including appearance.

Fresh incisions should be kept dry for two days after all drainage has ceased, so sponge-bathe only during this period. The wound should be sealed by 48 to 72 hours, so baths are safe after that. Older children may shower immediately post-operatively, as long as the shower head is not directed at the incision. If a drain has been removed from an incision, wait 48 hours after all drainage has stopped before bathing. Staples and non-absorbing sutures will be removed as soon as possible once the wound has sufficient strength, either prior to discharge from the hospital, or in the clinic.

If you notice frank redness or redness spreading beyond the area of the incision, please report this to us immediately. In general, the incision should hurt less and less every day. If the incision is becoming progressively painful, or if you see drainage of pus, please call us immediately. Itching is normal, and it usually suggests normal healing. It is very common after penile surgery for a yellowish-white, thick film to develop on the head of the penis. This secretion (exudate) is not pus, which is runny, and is a normal part of early scab formation.

Wound Dressings
For children who are still in diapers and who have an incision inside the diaper, the wound will be covered by a surgical glue to seal the fresh wound from urine and feces, promoting better healing. The glue will generally peel off in one to two weeks. Although the wound is sealed, we still recommend waiting 48 hours after surgery before submerging your child in bath water. If your child is older, he or she may have a Saran Wrap-like dressing over gauze, which in turn covers small strips (Steri-Strips) across the incision. This dressing allows your child to shower immediately after surgery without getting the incision wet. After three days, remove the clear plastic dressing and the gauze, leaving the Steri-Strips. These usually fall off in a week or two. Again, do not pull them off; allow them to fall off naturally. In general, dressings should usually be off by the third day after surgery, unless there is a drain present or there is persistent drainage.

Penile Dressing
If your child has had penile surgery and is in diapers, his penis will likely only be dressed with ointment.  If he is potty trained, the penis may be wrapped with a non-stick gauze. This is to control early swelling and to keep the penis from sticking to your child’s underwear. This dressing must not stay in place for more than two days, as infection may develop underneath it. Usually, we will ask you to remove this dressing the first time your child urinates or when he starts bathing.  If you cannot get this dressing off after several baths, or if the dressing appears to be acting like a tourniquet (constricting the base of the penis), please call us immediately.

Blood in the Urine
Bloody urine and small blood clots are common after urinary tract surgery. Blood is a powerful pigment, so it only takes a small amount to give urine a reddish tinge. In other words, if your child’s urine is bloody, it doesn’t mean he or she is necessarily losing much blood. Large or persistent blood clots are abnormal and should be reported to us immediately. The urine may stay blood-tinged for a week or more, and this is usually not a concern. The urine may alternate from being clear to bloody, and this is also normal, though the general trend should be towards getting progressively more clear.

Bladder Spasms
Bladders spasms are common after bladder surgery, especially if a tube has been left in the bladder for post-operative drainage of urine. Such bladder tubes may be left inside the body (ureteral stent), in the urethra (catheter), or through the abdominal wall (suprapubic tube). Bladder spasms usually come and go suddenly. Most parents report their child is fine one second then complaining of bladder pain the next. A baby might simply scream out of the blue. Usually, bladder spasms improve spontaneously as the days go by. If not, and if the urine is still bloody, please inform us, as there may be a blood clot in the bladder. If the urine is clear, and if your child has a tube in the bladder, the spasms may be present until the tube is removed. Tube removal is scheduled upon discharge from the hospital or surgery center, and the date of removal is scheduled as soon as possible after normal healing is expected. Premature removal of the tube may decrease your child’s chances for a good result, so we sometimes find ourselves with a patient with bothersome bladder spasms and a tube that simply cannot yet be safely removed. Certain medications can be helpful for bladder spasms, and one or more may be prescribed if this situation arises.

Urinary Retention
If your child is unable to urinate after surgery, please inform us immediately. This is often due to medication side effect, or possible a clot is present that is obstructing the flow of urine. If your child has a tube in place that you have been told is supposed to drain urine continuously, please monitor the tube for proper function and let us know if it is not draining properly. If your child has a suprapubic tube or a urethral catheter and normal voiding is noted, the catheter may not be plugged, so please inform us.

Surgical Drains, Stents, and Tubes
Surgical drains, stents, and tubes are placed at the time of surgery to promote good healing. Your child may or may not have one or more of these devices in place when he or she wakes up. If your child is admitted after surgery, most surgical drains are removed before you go home. Your child may be discharged from the hospital or the outpatient surgery center with a drain or tube in place, externally or internally. If you go home from the hospital or surgical facility with a drain, stent, or tube, a plan will have been made to arrange for removal of that device(s). You should receive detailed care instructions at the time of discharge. In general, and if you are properly prepared at the time of discharge, you should not find drain care very complicated. Tubes left in the bladder frequently cause bleeding and bladder spasms, so please review those sections above.

Your child’s activity level after surgery will be determined by your child’s age and the nature of the procedure performed. Any procedure that involves cutting of skin should be followed by at least 5 to 7 days of restricted activity. If one or more layers of the abdominal wall (i.e. hernia repair, orchidopexy, kidney or bladder surgery) have been cut, activity should be restricted for four to six weeks. This would include no heavy lifting, sports with any chance of contact, vigorous muscle activity (running, riding a bike, etc.). Heavy toys should be taken away from small children during the period of healing. Climbing is not permitted. Your will receive activity instructions at the time of discharge, and a copy of these instructions are usually considered sufficient for making adjustments at school.

It is extremely important that we see your child after surgery to make sure that a good result has been achieved and to arrange ongoing care, if necessary. Post-operative complications can be subtle, so do not assume that everything is fine, no matter how well your child is doing. When your child is discharged from the hospital or surgical facility, he or she will be given a follow-up appointment to see one of our providers.  If you are discharged after five p.m. or on a weekend, you will need to call when the office next opens and schedule the appointment. The interval between your child’s surgery and the follow-up appointment will depend on the nature of the operation performed.

Occasionally, families ask whether or not they will be charged for a follow-up evaluation after an operation. For most procedures, there is a period of time (the “global period”) after the procedure during which you will not be charged for care, unless certain circumstances occur.  This does not include office procedures, ultrasounds, lab tests, or care unrelated to the operation.  We are required by our insurance contracts to charge for care provided after the global period. Global periods exist so that you are not charged for things like taking out stitches or checking wound healing right after surgery. Global periods are brief because they are not intended to provide for ongoing free care. Our policy is to schedule post-operative visits when we feel it is time to assess your child final result.  If you believe that your child is not healing properly, please let us know and we will see your child immediately.  Because we cannot keep track of the different and ever-changing policies of various insurance companies, we typically charge a nominal fee for late post-operative assessments. This includes your copay, if you have one. If your visit has occurred during the global period, your insurance company will inform you and us. If you have paid a copay for a visit that occurred within the global period, your copay will be refunded, unless you have an outstanding balance. Please contact us if you are owed a refund.

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