Information for Patients Undergoing a Pulmonary Wedge Resection or a Lobectomy via Thoracotomy

Prior to Surgery

Do not take any nonsteriodial anti-inflammatory medication (e.g., Motrin Ibuprofen, Aleve) or aspirin products for 1 week prior or your surgery date.
Do not smoke cigarettes for at least 2-3 weeks prior to your operation; you may be tested the day of your operation to make sure you have not been smoking; if you have been smoking, your operation will be cancelled.
DO walk up to 2-3 miles a day prior to surgery to get yourself in the best shape possible.
DO use you incentive spirometer, at least 30 times a day (10 slow breaths, 3 times a day) and DO bring your incentive spirometer with you the day of your operation. You can leave it in the car or with your family member or friend until after surgery, when your friend/family member can bring it to you.
DO bring your blue blood sheet with you the day of surgery.

In the hospital/ immediately after surgery

You will have a few tubes and catheters after your operation. All of these are important and will allow us to monitor you while you are in the hospital.

Chest tube- This is a tube that is used to drain fluids that often accumulate in the chest after an operation inside. It is also used to remove any air that may be in the chest after surgery. Such air "leaks" as we call them, can happen for various reasons. We will show you while in the hospital the different parts of the chest tube "box", so you are aware what we are monitoring with regard to an air leak or increased drainage. Most of the time, both the fluid drainage and air leak need to stop before we can safely remove the tube. There are times when we will need to place a special portable one-way valve if you have an air leak which we think may take a little longer to resolve. You may go home with this one-way valve in place, and if you do, you will get special instructions for its care.
Epidural- For pain control we encourage an epidural catheter, which the anesthesiologist will discuss with you on the day/morning of your surgery. This epidural catheter is placed just prior to your surgery due to the special positioning needed to put it in. It is then used after surgery to help control your pain. It is a small catheter that is put in the space around your spine. The catheter is small enough that you are able to lie on your back after surgery. The catheter delivers pain medication in response to a button you control when you need pain relief. This catheter is used for only 3 days after surgery and is then removed before infection becomes a concern. Once the epidural catheter is no longer needed, you will be switched to oral pain medicine.
Please note that if you are uncomfortable with the idea of epidural anesthesia, or the epidural does not work for you, an alternative is a PCA, which stands for "Patient Controlled Analgesia". This is pain medicine that is infused into your IV. As with the epidural anesthesia, after 3 days we will stop it and switch you to oral pain medicine.
Foley catheter- This is a tube placed into your bladder during surgery, and used to monitor your urinary output. It typically remains in place for up to 3 days after surgery. Epidural anesthesia interferes with emptying of the bladder, so the Foley catheter is not removed until the epidural is no longer needed.
SCDs- (Sequential Compression Device) - These "pumps" are placed around your legs and used to keep the blood from pooling in your the calves. If the blood remains there for a period of time without movement, it can cause a blood clot. Other ways to prevent blood clots after surgery include, leg exercises such as ankle circles and pointing your toes to the ceiling then to the wall. You should do each 10 times every hour, on both legs. Most importantly you must walk after surgery (you may need some help getting up and out of bed the first few times).
IV- This is used to give fluids into your veins during surgery and after as needed.
Heart Monitor- most patients are placed on a heart monitor while in the hospital; this is done to watch for, atrial fibrillation, which occurs in up to 25% of patients after major chest surgery. When it does occur, post-operative atrial fibrillation can usually be corrected with medication and resolves within several weeks.
Incentive spirometer (IS) - this is a breathing exercise device. Along with coughing and walking, it helps to prevent collapse of the lungs and pneumonia. We realize that there is pain involved with surgery and the pain may interfere with deep breathing and walking. Please let us know if your pain is not well controlled, with your epidural, PCA or other pain medicine. There are other medications we can try to make sure you are as comfortable as possible.

After Discharge Following Surgery

Pain Management

You will be given a prescription for pain medication-DO NOT TAKE THE MEDICINE ON AN EMPTY STOMACH. If you choose to fill your prescription elsewhere, ask to make sure it is a medication that can be filled at your local pharmacy.
After your chest incision (thoracotomy) it is very common to have pain, and/or a burning sensation below your breast and the front of the rib cage on the same side as the surgery. This discomfort is caused from irritation of the nerve endings near your incision. Often the best way to help relieve this pain is to take a nonsteroidal anti-inflammatory medication (also know as NSAIDS) such as Motrin or Advil. Please note if you are on Prednisone, you should not take any NSAIDS. Also if you have ever been told to avoid these medications please do not take them. If you take an NSAID, please note that you must take this medication with food. We recommend Motrin or Ibuprofen 400mgs (an over-the-counter NSAID is 200 mg, so take 2 tablets) 2-3 times a day. You can take this in addition to your narcotic pain medication (Vicodin, Tylenol #3). You may also have been given a prescription for Ibuprofen. If so, you should not take additional over-the-counter Motrin/ibuprofen products.
You can also use a heating pad (not directly on your skin) and warm showers to help with some of the discomfort. Many patients also find it may be difficult to sleep in their own bed after surgery and make there way to a couch or lazy boy chair. This is not uncommon, and gets better with time.

Constipation

Pain medication can make you constipated. Please eat a high fiber diet, and take in plenty of fluids. If you have problems with your bowels while at home, you can try an over-the-counter laxative (Milk of Magnesia, Ducolax, Fleets enema) to help move your bowels. Please feel free to contact the office if you are having any concerns.

Taking care of the Incision

You will generally have one incision on your side about 6-8 inches in length. If you notice signs infection or inflammation- redness, drainage, swelling, or run a fever greater than 101.0 F, you need to contacts us. If your incision is in a place that you can not see, you may want to have someone look at your surgery site for you. The best way to keep it clean is to wash it in the shower with soap and warm water. It does not have to be covered unless you notice any drainage.
You will also have 1-2 Chest tube sites; these can also be kept clean with soap and warm water.

Taking out sutures

You may have a suture where the chest tube (drainage tube) was. This suture is not dissolvable and should be removed 5-7 days after your chest tube is removed. Your family member or primary care doctor can remove it. Otherwise you can come back to us to have this suture removed. The suture is pulled very tight. To remove it, pick up both ends, slip the scissors underneath, cut, and pull. It is a small "purse string" suture.
You may also have a blue suture loop at each end of your incision. There is a suture in the middle of your wound that is the same color. PLEASE NOTE THIS NEEDS TO BE CUT FIRST, before anything else is cut. If you are concerned or unsure at all, please wait until you talk with one of the nurses/physician assistants. Should you be thinking about removing a stitch on a weekend or in the evening, it is something that can wait until business hours, so we can be called if needed.

Activity and Restrictions

It is important to walk everyday, as well as to use your incentive spirometer everyday.
You will have lifting restrictions of nothing heavier than 10 lbs for 6 weeks (gallon of milk is 9 lbs) and then 25 lbs for 6 more weeks after this (3 month total), unless you were told otherwise.
If you are driving a long distance to your home, we recommend that you get out of the car and walk around every 2-3 hours to help prevent blood clots.