Post-Discharge Instructions and Medication Recommendations for Post-Operative Patients
For post-operative patients being discharged home, provide clear instructions on medication management, wound care, activity restrictions, and follow-up care, with opioids limited to no more than 7 days and a focus on multimodal non-opioid pain management. 1
Pain Management
Medication Protocol
- First-line pain management:
- For breakthrough pain only:
- Short-acting opioids (if needed)
- Prescribe no more than 5-7 days of opioids 1
- Dosage should be individualized based on inpatient opioid requirements
Opioid Management
- Prescribe opioids separately from non-opioid analgesics to allow for dose adjustments 1
- Patients should keep a record of all analgesics taken 1
- Avoid modified-release opioid preparations (including transdermal patches) 1
- Instruct patients to:
- Store opioids securely away from others
- Never drive or operate machinery while taking opioids
- Dispose of unused opioids at a community pharmacy 1
Weaning Protocol
- Follow reverse analgesic ladder: wean opioids first, then NSAIDs, then acetaminophen 1
Nausea and Vomiting Management
For Persistent Nausea/Vomiting
- First-line: 5-HT3 antagonist (e.g., ondansetron) 1
- Add if needed:
- Anticholinergic agent (e.g., scopolamine) or
- Antihistamine (e.g., meclizine) 1
- For severe cases: Consider adding dexamethasone 1, 2
Constipation Prevention
Protocol
- Increase fluid intake
- Increase dietary fiber if adequate fluid intake
- Exercise as appropriate 1
- For opioid-induced constipation:
Diarrhea Management
If Diarrhea Occurs
- Ensure oral hydration and electrolyte replacement
- Consider loperamide 4 mg PO x 1, then 2 mg after each loose stool (max 16 mg/day) 1
- Recommend bland/BRAT diet (Bananas, Rice, Applesauce, Toast) 1
Wound Care
General Instructions
- Keep the wound clean and dry
- Cover with clean, dry dressing if drainage present or if in an area prone to friction 3
- Avoid swimming until wound is completely healed (typically 1-2 weeks) 3
- Avoid heavy lifting or strenuous exercise that might strain the wound site for 1-2 weeks 3
Special Considerations
- For diabetic patients: More frequent wound checks and stricter wound care 3
- For facial wounds: Additional sun protection for 6-12 months to minimize scarring 3
- For wounds near joints: Additional activity restrictions to prevent tension on the wound 3
Activity Instructions
- Early mobilization is encouraged, starting within hours after surgery 1
- Gradually increase activity levels as tolerated
- Resume normal activities according to surgeon's specific instructions
- Return to work timing should be discussed based on type of surgery and job requirements
Follow-up Care
- Schedule follow-up appointment as recommended by surgeon
- Contact healthcare provider immediately if experiencing:
- Fever >101°F
- Increasing pain not controlled by prescribed medications
- Excessive bleeding or wound drainage
- Redness, warmth, or swelling at the incision site
- Inability to tolerate fluids for 24 hours
Documentation Requirements
- Discharge letter must explicitly state:
- Recommended opioid dose and duration
- Amount supplied
- Planned duration of use 1
- Clear instructions for medication weaning
Pitfalls to Avoid
- Avoid adding postoperative opioids to "repeat" prescribing templates; they should only be prescribed as acute medications 1
- Avoid prolonged opioid use - if patient is still taking opioids 90 days post-surgery, this should trigger further assessment for chronic post-surgical pain 1
- Avoid prescribing antibiotics routinely at discharge unless specifically indicated 4, 5
- Avoid requiring patients to urinate or drink clear fluids without vomiting before discharge, as this does not improve outcomes and extends recovery stay 1
By following these evidence-based discharge instructions, patients will experience improved pain control, reduced opioid consumption, and better overall recovery outcomes while minimizing complications.