Enhanced Recovery After Surgery Protocol

How you prepare for surgery can greatly enhance your recovery phase. Enhanced Recovery After Surgery (ERAS) is a new surgery protocol that streamlines patient processes before, during, and after surgeries.

This program aims to shorten the recovery period, drastically decrease opioid utilization, and facilitate early return to a daily routine while improving outcomes and overall surgical experiences.

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Preparation for Surgery

  1. Drink plenty of fluids starting 2 days prior to surgery. This will help prevent dehydration after surgery.
  2. Increase carbohydrate intake the day before surgery (carbohydrate loading) and eat nutritious foods. This will give your body the nutritional support to enhance its healing potential.
  3. Take vitamins before and continue for at least one-week post surgery. Particularly:
    1. Zinc: enhance immune system
    2. Calcium: support bone healing
    3. Vitamin C: support soft tissue healing
  4. Please consider taking a commercial Probiotic (Florastor, Bacid or similar). use as directed while taking the antibiotic to help promote a digestive system.
  5. Take Motrin (ibuprofen) 400-800mg (as directed by your doctor) prior to 2 hours to surgery. This will give you a head start on pain and swelling control.

Postoperative instructions

Please follow instructions as designated, doing so will add to your comfort and hasten your recovery.

Anesthesia often leaves the lips, teeth, tongue, and even the nasal area numb after an oral operation: avoid chewing and hot liquids until the numbness wears off to prevent accidental injury. Taking ibuprofen or Tylenol prior to the local anesthesia wearing off can significantly reduce pain and swelling. Temperature and pressure sensitivity, as well as gum soreness, is to be expected in the days after your procedure.

After a tooth extraction, it is crucial that a blood clot form in the extraction socket. Do not smoke, drink through a straw, or rinse forcefully for at least 5-7 days after the procedure. Drink directly from the glass or use a spoon.

Some bleeding following oral surgery is to be expected and slight oozing may persist for the first 24-48 hours after surgery.  Firm pressure applied over the surgical area(s) with gauze or a moistened tea bag will control the bleeding.  Do not chew on the gauze. If bleeding starts again, put gauze, a clean white cloth, or a damp teabag over the bleeding area and bite on it with firm, steady pressure for one hour. Do not chew on it. Do not take aspirin or aspirin products, since they may prolong bleeding. If pressure on the surgical site does not control bleeding please call your doctor.

Some degree of swelling and discomfort following the surgery is to be expected. Discoloration and a slight stiffness of the jaw can be normal post-operative events. Do not be alarmed, swelling is expected to peak on the third day and may last for several days.

Good nutrition must be maintained following oral surgery. PLENTY of liquids are needed at first, and the diet should be increased to soft or regular foods as soon as you are able. Do not miss meals, even though soreness and jaw stiffness may be present. Examples of food which you may consume following oral surgery are non-acidic juices, smoothies, ice cream, puddings, yogurt, Jell-O®, soup broth, scrambled eggs, pureed or blended foods.

Good hygiene is important for normal healing. You can brush teeth unaffected by the surgery, along with gentle tooth brushing of the teeth adjacent to the surgical area. Avoid undue irritation to the surgical site. Do not begin mouth rinses until the first day following surgery; at that time use ¼ teaspoon of salt in an 8-ounce glass of warm water 4-6 times a day.

Oral surgical procedures are often accompanied by facial swelling and this should not be cause for alarm. A noticeable increase in this swelling may occur during the second or third post-operative day and is expected. You may help minimize the swelling by applying an ice bag on the face 20 minutes on and 20 minutes off until bedtime the night of surgery, then discontinue. The day after surgery and for several days after, moist, warm heat applied over swelling can be helpful. You may also consider using Arnica Montana, a natural supplement; it has been used medicinally for centuries to help reduce postoperative swelling, pain, and bruising. Side effects are benign and limited to local redness or slight burning sensation. It is available over the counter. Apply to the skin of the face over the surgical site 3-4x daily. Do not apply orally or over broken skin.

Resting with the head slightly elevated the first one to two days following surgery will make your post-operative course more comfortable. Avoid physical exertion or exercise on the day of surgery. Increase your activity level as tolerated.

Sutures (stitches) may have been used to repair the surgical site. They will generally dissolve in 5-7 days. However, it is common for the sutures to loosen or become dislodged in 2-3 days or remain beyond 7 days; this is acceptable and should not be cause for concern.

A white area will likely form in the region of the surgical site, this is part of the normal healing process and does not constitute an infection.

After an extraction, the tooth socket (hole in the jaw) will remain open for 4-6 weeks. This is part of the normal healing process. Keep the socket clean of food particles by rinsing with water after each meal until the socket is closed.

Antibiotics can sometimes render birth control pills less effective. If have been prescribed an antibiotic and are on birth control pills, use an additional method of contraception for the remainder of your current menstrual cycle.

Lactobacillus acidophilus (Bacid) is a probiotic that has been used to re-establish the normal consistency of bacteria in the gastrointestinal tract (stomach and intestines) and vagina. Antibiotics kill bacteria but don’t discriminate between “friendly and “unfriendly” microorganisms, so the balance between good and bad bacteria in the intestines and vagina can be upset resulting in diarrhea or vaginitis. It is thought that taking probiotics helps restore the healthy balance of bacteria. While taking an antibiotic you may choose to take a probiotic, generally 2 capsules 2-4 times a day, or use as directed on the product packaging.

If you have received any sedative or general anesthetic for your oral surgery, you should not drive any vehicle or attempt any hazardous tasks on the day of surgery.

Many surgical procedures require the use of pain medication post-operatively which can make you drowsy, therefore, do not drive while taking such medicine.

Pain medication:

  • Use the prescribed medication as directed for pain.
    • If you take Motrin (ibuprofen) prior to surgery, then take your next dose 6 hours later and continue on a schedule every 6 hours for 3-5 days then resume as needed.
    • Motrin works best when taken on a regular schedule to reduce pain and inflammation.
  • The local anesthetic should wear off around 2 hours after surgery. However, this is quite variable.
    • If you did NOT take Motrin prior to surgery, we recommended your first dose of pain medication be taken before the anesthetic wears off to help control postoperative discomfort more effectively.
    • If you did take Motrin prior to surgery, you may take Tylenol (acetaminophen) as the anesthetic starts to wear off if you start to feel mild discomfort before your scheduled post-op dose of Motrin (6 hours after the first dose).
  • Please note that a tolerable baseline level of pain is acceptable to help modulate activity and protect the surgical site.
  • The following is a safe and effective pain control method:
    • Alternate between:
      • Acetaminophen/APAP (325 or 500mg)
      • Ibuprofen (400-600mg mg per capsule/tablet) or Aspirin (ASA) 325mg
      • Take the medications 3-4 hours apart as needed for pain.
    • Only if you experience breakthrough pain, take the prescribed narcotic/opioid medication (typically hydrocodone/Norco) as directed for pain that is not controlled by following the regimen above.
    • Please note that most narcotic formulations have 325mg of acetaminophen (Norco has 325mg of acetaminophen). Therefore, factor that in when calculating your maximum daily dose of Tylenol (acetaminophen).
      • Please note: The maximum daily healthy adult dose of acetaminophen (Tylenol) is 3000-4000mg under the direction of a health care provider.
      • The maximum daily healthy adult dose of Ibuprofen is 3200mg.
    • You may electively use Arnica cream, which helps reduce postoperative bruising and swelling. Apply to the skin over the surgical site 3-4x daily (do not apply intraorally).

Antibiotic:

  • If you were given an antibiotic, please take it as directed on the prescribed schedule until all the medication has been taken.
  • Please consider taking a commercial Probiotic (Florastor, Bacid or similar). use as directed while taking the antibiotic to help promote a digestive system.
  • Continue the probiotic for at least one week after finishing the antibiotic regimen.

Important Safety Tips:

  1. Never take an opioid pain reliever unless it is prescribed for you.
  2. Always take opioids as directed. Do not take more opioids or take them more often than is prescribed for you.
  3. Do not use opioids with alcohol or other drugs unless approved by your prescriber.
  4. Protect and lock up your opioids in a safe place at all times, and properly dispose of leftover medicine.
  5. Never share opioids with another person; it is illegal and very dangerous.
  6. Be prepared for opioid emergencies. Know signs of trouble and what to do.
  7. Always read instructions that come with your opioid prescription. Contact your prescriber or pharmacist with any questions.

Guidelines for Drug Disposal

Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.

  • Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government’s household trash and recycling service (see blue pages in the phone book) to see if a take-back program is available in your community. The Drug Enforcement Administration, working with state and local law enforcement agencies, is sponsoring National Prescription Drug Take-Back Days (www.deadiversion.usdoj.gov) throughout the United States. Drug disposal center 5350 2nd St NW, Phone: (505) 823-4200
  • If no instructions are given on the drug label and no take-back program is available in your area, throw the drugs in the household trash, but first:

° Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to peo­ple who may intentionally go through your trash.

° Put them in a sealable bag, empty can, or another container to prevent the medication from leaking or breaking out of a garbage bag.

  • Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.
  • Do not give medications to friends. Doctors prescribe drugs based on a person’s specific symptoms and medical history. A drug that works for you could be dangerous for someone else.
  • When in doubt about proper disposal, talk to your health care provider or pharmacist.

It is our desire that your recovery is as smooth and pleasant as possible. Following these instructions will assist you, but if you have questions about your progress, please call the office at 881-1130 during regular office hours. After office hours a 24-hour answering service is available to contact your doctor. Calling during office hours will afford a faster response to your question or concern.

PLEASE NOTE: Request for narcotic/opioid pain killer cannot be taken over the phone and will only be considered following an office visit during business hours.

A professional association devoted to the practice of Oral and Maxillofacial Surgery (7-2021)