Need an Arsenal to support Ice

[Nola]

Give me a few and I'll site my references.  It isn't the hair that is the issue, it is the micro abrasions that the skin gets when shaved you open a portal for bacteria to enter before surgery and the key factor is time.  The closer the shave to incision time the less likely you are to getting a PO infection.  Give me a few and I'll see if I can locate the references.

[UK Girl !]

just saying it sounds strange - as like before you go in for an op here they say to shave the area - I understand what you are saying but it doesn't seem to be taken into account here!

[Nola]

It has been widely known in the surgical arena since the 80's any how that there has been associated Surgical Site Infections (SSI's) based on shaving patients before surgery.  It used to be widely practiced in the States that you would be admitted the night before surgery so you could get "prepped" which included the "shave". then they (Hospitals) started trimming costs and having patients come in the morning of surgery and have there "prep" and guess what happened?  SSI's decreased.

Here are a couple references,

Ann Ig. 2005 Sep-Oct;17(5):401-12. LinkOut
[Preoperative hair removal review][Article in Italian]
Orsi GB, Ferraro F, Franchi C.
Dipartimento di Scienze di Sanita Pubblica, Universita degli Studi di Roma "La Sapienza". giovanni.orsi@uniroma1.it

Surgical site infection (SSI) frequency is influenced by several risk factors, among which perioperative hair removal. Traditionally it is part of the procedures carried out on skin before surgery. Although preoperative shaving is widely used in many hospitals, its use should be re-evaluated. Therefore the AA. carried out a systematic literature review about the opportunity, the modality and the risks associated to preoperative hair removal. We found first of all that preoperative shaving (razor) is associated with a significantly higher surgical site infection (SSI) risk. Second, when hair removal is considered necessary by the surgeon, it should be carried out by means of a clipper or depilatory cream. Furthermore hair removal should be performed immediately before surgery and not in advance, to avoid an increased risk of SSI.

PMID: 16353677 [PubMed - indexed for MEDLINE]



AORN J. 2002 May;75(5):928-38, 940. Links
Preoperative hair removal--a systematic literature review.Kjonniksen I, Andersen BM, Sondenaa VG, Segadal L.
Norwegian Centre for Health Technology Assessment, Oslo.

This article describes a systematic literature review on whether, how, and when to perform preoperative hair removal. By searching electronic databases and reference lists of relevant articles, team members identified 20 clinical studies that deal with preoperative hair removal. No strong evidence was found to advocate against preoperative hair removal. Furthermore, there was strong evidence to recommend that when hair removal is considered necessary, shaving should not be performed. Instead a depilatory or electric clipping, preferably immediately before surgery, should be used.

PMID: 12063942 [PubMed - indexed for MEDLINE]


This last one is a CME course for physicians and nurses to educate on Medicare's Evidence Based Medicine - Quality Improvement Project it is called SCIP Surgical Care Improvement Project
http://www.medscape.com/viewprogram/5402_pnt


Sorry for the long post, but if it helps anyone from getting into trouble That's the Blah blah blah

[Kai]

Once again.. Nola.. thanks for an insightful and informative post.  Its getting to the point that if you recommended a brain transplant for me Id do it..  Hope your recovery is going well.

[lescycling]

Nola,
Sorry to hear you are in lot of pain!
I had power Pump ( attached to my knee ) for 4 days it helped a lot before my drugs faded away.

I too, purchased Crayo Cuff and love it, but I also saw my PT use " ColPac" Cold Terapy Gel type pillow. I love becouse is big size , about 9" X 12" so raps around your knee very nice! it goes in the freezer than on your knee. It was the best 25$ I invested , I still use both of them . Thy would put thsi pillow gel pac in the pillow cover , so is not to cold to your knee, than raped with bandage for good contact and some compression.
I hope this help,

Best of luck,
lescycling

[Mirek]

Hey Nola,

I am surprised at the lack of ice - my OS, the PT and the sports medicine doctor all drilled it into me to ice as often as I could.  When I came out of my anaesthetic, my knee had a cryo-cuff on it with a tensor bandage around that and the nurse was putting fresh charge of ice water into it.  They sent me home with it and just said return it when I was done with it - trusting lot they are here!

I had my surgery at 7:45 AM and was home by 2:00 PM.  The only pain I had was when the inital morphine shot wore off later that same day - it hurt!!  They had given me some oxycodone and after popping a couple of those I felt better and then the home nursing staff which my OS arranged came that evening and gave me more morphine before bed time (which occurred about 10 minutes after the morphine shot!)  They came one more in the morning and gave me another shot, but I do not think I needed it as the oxycodone was working fine by then.  I weaned myself off the oxycodone 5 days post - op and once the drugs had worked out of my system I felt so much better.  I just hate pain killers, but they have their place!

Hope you got your ice and are still getting it!

Mirek

[L. Thomas.net]

Nola
I know you are using ice cubes.  I thought this was a good idea.  It was posted on the board for products you couldn't do without.


I have been reading about everyones ice tips and what they use for ice packs. My therapist gave me a great recipe for making a slushy ice. I keep 3 bags of it in freezer and rotate each time i need them to allow them all to stay cold. This is much better then using ice cubes and better then some of the store bought ice packs

ICE RECIPE

1 gallon size ziploc bag (I double mine to make sure not to leak)
3 cups of water
1 cup of rubbing alcohol

Freeze until cold and slushy

The alcohol keeps the ice at slushy constitency, and it forms well around your knee.

[Nola]

What a phenomenal idea!!! Thank you so much.  I don't have any rubbing alcohol here except for prep pads.  It is Sunday and all the stores in the village are closed so I have improved the recipe.

Necessity is the mother of invention, right??? Well, we have a winery, and when we rack the wine barrels we remove the wine by siphoning the top and the wine with all the sediment stays at the bottom.  That wine at the bottom does not go to waste, we distill it and make Orujo (Grappa, Aguardiente, Firewater, probably has about a million names). Anyway, I have plenty of 80 proof alcohol which I used in place of the rubbing alcohol.  If I run out of pain pills, I can drink my slushy...LOL!!!  Now that's an improved recipe, you couldn't do that with the rubbing alcohol.
Cheers!

[knee deep in Goo]

All I can keep thinking of is red wine spilling.  I am sure that is not the case..    But a nice mix of vodka and apple pucker..(apple martini)   Is that shaken, stirred or kneed warmed and squished?

[Nola]

Kneed warm and squished probably better,  OMG it works like a slushy charm...  The color of the wine is completely removed when you distill (you are only getting the pure alcohol from the wine in a super concentrated form- actually the same as vodka except instead of the fermented potatoes, our start is wine)

Mirek, I got lots of "surprises" here in Spain
1. I didn't get the allograft for which I was mentally prepared. I am very happy with the choice I made with the BTB autograft.
2. The cultural difference the Spaniards have when it comes to pain
3. No Vicodin or Darvocet in this Country (all I had was Darvocet - my stash I had reserved for my migraines which I get infrequently) Hubby had some old hydrocodone.
4. And the biggest surprise was no ice.  Not a single cube in the hospital and when I asked my OS about it he looked at my hubby and said use it if you want but I don't usually use it.  Hubby feels that ice is only of benefit during the first 24 - 48 hours after surgery because initially you want the vasoconstriction it provides, but there after you don't want constant vasoconstriction instead vasodilatation to increase blood flow induce healing. Thus in the end I did not get my automatic icer I was really hoping for.  I have been using cubes. So this slushy is absolutely marvelous

[knee deep in Goo]

Odd.  So what did they give you for pain control.   A rag to chew on ?

[Audice]

ICE RECIPE:1 cup of rubbing alcohol

I used the same recipe when I injured my knee but my recipe called specifically for 91% isopropyl alcohol rather than the usual 70+ % we generally use. I did find the higher percent alcohol at the local pharmacy & made several bags of slush. They worked wonderfully. Still have a couple in the freezer...Ellie

[Nola]

Basically yea.  No, 1st 27 hours in the hospital I had my femoral block... worked great.  I was posting the evening I had surgery, I felt pretty good. At about 3pm the next day, I started having pain.  They use Paracetamol(tylenol) and Nolotil (antiinflammatory) both IV, took the slight edge off.  OS came in and saw I had been crying and he said he would right for something stronger.  He got to talking at the nurses station, and forgot my something stronger, this was at about 9pm.  Hubby left shortly after that the nurse came in with more tylenol and nolotil and I was hysterical at that point. I told her I did not understand this country for in my country when a PO pt says they're in pain you get them drugs.  She had the house doc in within 5 minutes I got Demerol and a sedative. I slept.  First few days at home I used my stash and the hydrocodone, since then I have been using Tylenol #3 and my antiinflammatory.  

The story I have been told, is that the Spanish government keeps tight control on narcotic production.  Even though Hydrocodone is 2 or 3 times the strength and efficacy as codein, they are both basically the same drug.  And obviously the codeine is less expensive to manufacturer and sightly easier to control abuse. If you take too many codeine, you start throwing up.  I don't know about injecting codeine, but vicodin is one of the most abused narcotics in the US, it is so easy to get, and it is strong. I am icing with my orujo slushy now, sweet heaven!!!  

[Mirek]

Hey Nola,

Great to hear you are at home, but sorry to hear all the pain you endured.  I am amazed at the range of responses from everyone about the pain and the pain killers, as well as icing. I guess we are all different and our surgeon's all do it a little differently.  I had my surgery early in the morning and they gave me a morphine shot when I was in recovery.  It wore off about 6 that evening and the pain came on fast.  I took one oxycodone which was not enough, but I was reluctant to take more as I did not know if it would react with the morphine and home nursing was coming that night to give me second shot before bed time, so I hung on through the pain.  Generally, I am with Zengirl and others who kicked the narcotics ASAP, however, I am no hero, it is just that when I cut back to one pill before bed 4 days post op, then cut them completley thr next day, I just did not have pain - I guess I am just lucky.  Now,17 days post op, I find in late afternoon it aches a bit if I have been on my feet all day and I take a motrin which works just fine.  At physio on Friday I was just 5 degees from zero extension and 118 flexion - it is coming back in leaps and bounds as the swelling dissapates.  I am walking normally now albeit with a shorter stride.  I stopped icing about 10 days ago as it was giving me body chills and making me miserable.

Hope the recovery keeps coming fast for you!

Mirek

[zengirl]

Mirek you must be YOUNG!!!!! Your recovery is incredible. It is over nine months since I had my operation and today my physion measured my flexion as being 115 - same as it was two weeks ago. I am about nine degrees off full extension - but that is MASSIVE progress and to all intents and purposes for me that is full extension. I have not known what it's like to have a straight leg for nine months and it is lovely.