Preoperative Instructions for Major Orthopedic Surgery – Chris S. Pallia, M.D.


When you’re contemplating a major orthopedic surgery, you really have to start thinking about the surgery, at least one week ahead of time. And basically, you need to stop all anti-inflammatory medications one week prior to surgery because they are blood thinners.   They’ll lead to increased bleeding and bruising and more pain and stiffness after surgery.

So, you need to stop all NSAID’s including Aspirin, Naprosyn, Motrin, Ibuprofen, Aleve, Advil, Voltaren, Meloxicam and others.

There are also some other blood thinners that people don’t really know about.   There are supplements that should also be stopped for major orthopedic surgery, such as hip and knee replacement surgery. Those include fish oil, vitamin E and also red wine.   Red wine has reservatrol which acts as a slight blood thinner. You must remember to look at all your supplements and vitamins before surgery.

Furthermore, if you’re on any pharmaceutical blood thinners at all such as Coumadin, Plavix, those need to be discontinued before surgery. Plavix needs to be stopped seven days prior and Coumadin, four days prior to surgery. There are many other blood thinners such as Xarelto, Eliquis and others – but I would refer you to discuss these with your physician.

Pre-operatively, for healing purposes, we want to stop all tobacco use, including electronic tobacco and smoking for at least four days prior to surgery and at least a week after surgery to allow the wounds to heal.    On the night before surgery, you should have nothing to eat or drink after midnight, or specifically 8 hours prior to surgery.  On the morning of surgery, if you’re on any cardiac medications, antacid medications, or diuretics, those should be taken (on the morning of surgery) with a very small sip of water.

Obviously if there are specific recommendations by the hospital or surgery center preoperative nurse that differs from above, please discuss this conflict with your healthcare team.

I’m Dr. Chris Pallia.  Good luck with all your surgeries in the future and if you have any further questions, please don’t hesitate to call my office at (619) 435-7282.

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