Before the operation:
2 weeks before the operation you should not take any ASA. Non-steroidal anti-inflammatory medications such as Motrin, Ibuprofen (Advil), Naproxen or any medications containing these drugs can be taken up to five days preoperatively. Celebrex and Mobicox may be taken up to the day prior to surgery. All herbal medications should also be avoided as they can interfere with normal blood clotting and anesthetic agents. If you take pills for high blood pressure, you should still take them the morning of surgery with sips of water. One of the risks of the surgery is post-operative bleeding which will be less likely if these instructions are adhered to. There are many new blood thinners now being used which each have a different duration of effect. Please make certain you review this with the office so you are only off of them the appropriate amount of time.
Patients may attend a pre-operative tour at the hospital where blood work and pre-operative testing will be done if any has been ordered. Most healthy patients do not require a pre-operative appointment and will receive a reminder phone call or email to confirm surgery 2-3 weeks in advance.
After the Operation:
You will be discharged the same day of the operation. You should have someone with you the first evening. It is normal to have some blood come from the nose for up to 2 weeks after the operation. You should not have brisk nasal bleeding. Blowing your nose should be avoided for at least 3 days, and then only gently afterwards for 2 weeks.
There may be small packs in the nose to keep the sinuses open after the operation. These can be dissolvable or removable. If they need to be removed, it will be done about 2 weeks after the surgery. You should call the office to confirm your appointment time. If they are dissolvable you will still be seen approximately 2 weeks after the surgery. You are usually sent home with a small gauze dressing under the nostrils to catch any small amounts of blood.
If the tape from the nasal gauze causes local irritation this can be managed by using a cotton ball at the end of the nostril to soak up minor bleeding as an alternative. Once any dripping has stopped this is no longer required. You should keep your head elevated for the first two days post operatively, to reduce intra nasal swelling and bleeding. Blood thinners should not be resumed if there is any active bleeding.
You should not use your steroid nasal spray for 3 weeks after the surgery while things heal. You should purchase a Saline Nasal Spray or Hydrasense medium nasal spray for the first five days post op. You will then use Neilmed Sinus rinse spray two or three times daily for up to 3 months after surgery. Pulmicort a topical nasal steroid is sometimes prescribed to be added to the rinse and a prescription will be provided if this is indicated in your case.
Often patients will notice a mild improvement in symptoms after surgery and will have progressive reduction of symptoms over a period of 6-10 months following surgery. You will still be able to get sinus infections, but they should be less intense, less frequent and last for a shorter period. If you are feeling any improvement after 2 months you should call to arrange an additional follow up. Sinus surgery is generally effective in about 90 percent of patients. The remainder may need additional topical therapies or in some cases revision surgery. This can be determined on close follow up if required.
Medications Recommended To Have At Home After The Operation:
Otrivin: If there is persistent minor bleeding this can be sprayed 2-3 sprays in the affected side and should slow this down. If brisk bleeding persists, it is recommended you go to the emergency room.
You will be provided with some Tylenol 3 or Percocet but should try to use extra strength Tylenol or Celebrex as primary management for the first 2-3 days.
Once bleeding is minimal Advil or Motrin are excellent options as well and can be used safely.
Gravol to manage post op nausea. Usually 25-50mg every 4-6 hours as needed.