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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Dear Patients:

As most of you are aware, over the last several days and weeks we have been learning about the coronavirus (COVID-19) and how it is impacting our world.  At Synergy Orthopedic Specialists, we have one goal that we strive for, and that is to keep you, our patients, and our employees safe.  This has been the topic of our planning and conversations and we have implemented several measures to ensure that we do everything possible to reduce the threat of this disease.

Our offices are regularly cleaned and sanitized, but we are now ramping up those procedures to include wiping down counters and other surfaces more frequently.  Additionally, we have hand sanitizer available, and washrooms for thorough hand washing.  We are closely following the Centers for Disease Control’s (CDC) guidelines and recommendations to help prevent the spread of the virus.

Our employees have been instructed to frequently use antiseptic hand cleaner as well as handwashing per the CDC instructions.  We also encourage our patients to do the same. If our employees feel sick or begin running a temperature, they have been instructed to stay home.  Similarly, we request that patients who are not feeling well, reschedule their appointments and not come to our clinics while they are ill. 

If our employees become ill, our offices may be functioning with less that optimal staffing; therefore, we request your patience if there are longer than average wait times or other delays.  Any location that may have any direct exposure, will be quarantined for cleaning.

We will continue to closely monitor the situation and do all that we can to protect you and our employees.  For more information and guidelines on the Covid-19, please visit:

Thank you