Surgical recovery and rehab
Natural Standard Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
Cardiac rehabilitation, geriatric rehabilitation, invasive medical procedures, nasal surgery, pain, perioperative health, postoperative, postoperative atelectasis, pouchitis, preparation for surgery, rehabilitation, vestibular rehabilitation.
Surgery is a medical procedure that involves operating on a patient in order to repair, replace, or remove a damaged part of the body. In some cases, a surgical procedure (such as a biopsy) may be used to diagnose an illness.
More than 25 million surgical procedures are performed each year in the United States.
A planned surgery generally involves four steps: a surgical consultation, a pre-surgical visit, surgery, and patient discharge. These steps ensure that the patient understands the potential risks and benefits of the procedure. They also ensure that the patient is healthy enough to undergo surgery with minimal risks of complications.
During the surgical consultation, the surgeon meets with the patient to discuss the procedure and answer any questions. Patients who are unsure if they want to undergo surgery can visit another doctor for a second opinion. Patients should contact their health insurance companies to determine if procedures are covered.
A day or two before surgery, the patient meets with the surgeon and anesthesiologist for a medical examination. The purpose of this visit is to make sure the patient is physically ready for surgery and to determine the safest anesthesia for the patient.
On the day of surgery, the patient is admitted to the hospital. The patient is prepped for surgery and brought to the operating room, where the surgery is performed.
After surgery, the patient either stays at the hospital for a certain amount of time to recover, or the patient is sent home. When the patient is released from the hospital, the doctor provides instructions on how to take care of him/herself.
An emergency surgery is not planned ahead of time. This surgery is performed when the patient's life or wellbeing is in danger. Because the medical team has less time to perform the surgery and less information about the patient, there is a higher death rate associated with emergency surgeries than planned surgeries.
The length of time it takes to recover after surgery varies depending on the specific type of surgery, as well as the patient's age and overall health.
Recommendations Before Surgery
General: Listed below are general recommendations before a planned surgery. Patients who are preparing for surgery should strictly follow the instructions of their healthcare providers.
Surgical consultation: During the surgical consultation, the patient meets with the surgeon to discuss the procedure. The surgeon will discuss the potential risks and benefits of the surgery to ensure that the patient is making an informed decision about the surgery. This is also an opportunity for the patient to ask any questions he/she may have about the procedure. It is a good idea to write down questions ahead of time to make sure they are not forgotten. Individuals may also wish to bring a friend or family member to help them take notes and ask questions.
Pre-surgical visit: The pre-surgical visit is usually one day before surgery. During the visit, the doctor will examine the patient to make sure he/she is in good medical condition to undergo surgery. The patient's blood pressure and temperature are taken. Blood and urine tests may also be performed. The doctor will also determine what type of anesthesia is safe for the patient. The patient should be prepared to answer many questions. For instance, doctors typically ask if the patient is taking any drugs (prescription, over-the-counter, or recreational), herbs, or supplements. The doctor may also ask if the patient has any food or drug allergies.
Do not eat before surgery: In order to avoid complications after surgery, the patient must limit what he/she eats and drinks before surgery. This is because it is possible for food to be vomited and inhaled into the lungs (called aspiration) during surgery. Most procedures require patients to abstain from food and drinks after midnight before surgery. This includes gum and candy. Diabetics may need to follow different guidelines. Patients should ask their healthcare providers about drinking clear liquids. In some cases, patients are allowed to drink one eight-ounce glass of clear liquid (including water, black coffee, or apple juice) up to two hours before surgery. Patients should not drink alcoholic beverages for 24 hours before surgery. On the day of surgery, be sure to tell the doctor or nurse if any food or drinks were consumed after the time the patient was told to stop eating or drinking.
Avoid certain drugs, herbs, and supplements: During the surgical consultation and pre-surgical visit, the healthcare provider will ask if the patient is taking any drugs (prescription, over-the-counter, or recreational), herbs, or supplements. The healthcare provider will let the patient know if any of these substances are unsafe to take before surgery. In many cases, drugs, herbs, or supplements are avoided before and after surgery to prevent compilations or interactions.
Do no smoke: Patients who smoke are advised not to smoke after midnight before surgery. If patients are unable to stop, they should try to reduce the amount they smoke.
Do not wear accessories or makeup: It is recommended that patients do not wear jewelry when they are admitted to the hospital. This is because the jewelry will need to be taken off during surgery. Do not wear any makeup, including nail polish, on the day of surgery. This is because makeup may contaminate the incision or hide important signs of surgical complications. For instance, nail polish must be removed because healthcare professionals need to be able to see the fingernail to check the patient's circulation.
The Day of Surgery
Sign a consent form: On the day of surgery, the patient will sign a consent form. This form indicates that the patient understands what the surgery is for, as well as the potential risks and benefits.
Check in: On the day of surgery, the patient is admitted to the hospital. The patient will be given a medical identification bracelet and a medical gown to wear.
Medical exam: The healthcare provider will perform a brief medical exam immediately before surgery. This ensures that there are no changes in the patient's health, and the patient is still able to undergo surgery. Patients should tell their doctors if they are taking or were taking any drugs (prescription or over-the counter), herbs, or supplements. Patients should also be prepared to answer any questions about their medical history.
The anesthesiologist will recheck the patient's medical history and test results. The anesthesiologist may then give the patient a sedative to help him/her relax before surgery. This sedative may be taken by mouth or injected into a vein.
Transportation to surgery: The patient is then taken to surgery in a wheelchair or a bed (called a gurney), even if the individual is capable of walking. This ensures that the patient will get to surgery safely.
In some cases, patients are brought to a waiting area (called a holding area) before they are taken to the operating room. Sometimes (especially when the patient is a child), one or two of the patient's friends or family members are allowed to wait in the holding area with the patient. If the patient needs to have his/her hair shaved, this may also be performed in the holding area.
The patient is then taken to the operating room (OR).
Anesthesia is given: Once patients are in the OR, they are given anesthesia. There are three types of anesthesia: general anesthesia, regional anesthesia, and local anesthesia. General anesthesia causes the patient to fall asleep and feel no pain. Patients who receive general anesthesia will be intubated, which means they will have a tube placed in their throats to help them breathe while they are asleep. Regional anesthesia is used to numb a general area of the body, such as an arm or leg. Local anesthesia is used to numb more specific parts of the body, such as an area of skin on the arm.
Recovery room: Once the surgery is over, the patient is brought to the recovery room, also called the post-anesthesia care unit (PACU). The patient is closely monitored as the anesthesia starts to wear off. As the patient starts to wake up, a nurse will give the patient medication to reduce any pain from the surgery. Most patients spend one to four hours in the PACU.
In the meantime, the surgeon meets with the patient's family and friends to let them know how surgery went. The surgeon will also answer any questions they may have.
Surgeries that required local anesthesia (such as biopsies) may be performed in a doctor's office or hospital and have shorter recovery times.
Discharged: Patients who underwent minor surgery and are in good condition are discharged from the hospital. Outpatients must be able to drink fluids without vomiting, be able to sit upright without fainting, and urinate on their own before they will be sent home.
Patients who underwent more serious surgery are admitted to a room in the hospital. When the doctor is satisfied that the patient's condition is stable and pain has been treated appropriately, the patient is sent home.
Once discharged from the hospital, patients should not drive or operate heavy machinery for at least 24 hours. Alcohol should not be consumed for at least 24 hours as well. Upon leaving, the doctor will give the patient instructions (called discharge instruction) on how to care for him/herself. Patients should follow these instructions exactly. Patients should talk to their doctors if the directions are unclear or if they have any questions.
Signs and Symptoms
General: After surgery, the body beings the healing process. The exact signs and symptoms that develop after surgery depend on the specific type of surgery, as well as the patient's age and overall health. In general, some of the most common symptoms include inflammation, pain, general soreness or stiffness, sore throat/hoarseness, and nausea and vomiting.
Inflammation: The area of the body that received surgery is typically swollen. It may also be appear red or flushed.
Pain: Patients are generally sore after surgery. The amount of soreness and pain after surgery depends on the specific procedure. For instance, open-heart surgery causes more postoperative pain than a hernia repair.
Sore throat/hoarseness: Patients who receive general anesthesia often experience a sore throat and/or hoarseness after surgery. This is caused by the intubation tube that is placed in the throat to help breathing.
Nausea and vomiting: Patients often experience mild to moderate nausea and possibly vomiting when they wake up from surgery. This reaction may occur in response to anesthesia. Nausea may last for anywhere from one to 36 hours.
Aspiration: It is possible for food to be vomited and inhaled into the lungs during surgery with general anesthesia. This serious complication, called aspiration, may lead to suffocation or a lung infection called pneumonia. This risk is minimized by avoiding foods and beverages 24 hours before surgery. Also, the U.S. Food and Drug Administration (FDA) recently approved a prescription drug, called the scopolamine patch, to prevent nausea and vomiting during and after surgery.
Bleeding: It is normal for some bleeding to occur during surgery. Bleeding is usually controlled during surgery and stopped once surgery is complete. However, excessive bleeding may occur during or after surgery. This may happen if an artery or blood vessel is cut during surgery. Some minor bleeding may also occur from the incision. However, patients should seek immediate medical treatment if the incision bleeds more than the healthcare provider told the patient to expect.
Infection: The surgical wound may become infected. An infection develops when bacteria enters the incision cite. Infections may delay healing. Infections may also enter the bloodstream and infect other organs and tissues throughout the body. A serious infection may lead to a life-threatening condition called shock. Symptoms that the condition may be progressing to severe sepsis or septic shock may include confusion, reduced mental alertness, skin rash or bleeding, warm and flushed skin, decreased urine production, and dizziness (caused by low blood pressure).
Postoperative atelectasis: Atelectasis, or a or collapsed lung, occurs when the lung is unable to fill completely with air. Atelectasis is a common complication in patients who undergo chest and upper abdominal surgeries.
Reaction to anesthesia: Although rare, some patients have life-threatening reactions to anesthesia. Symptoms may include dizziness, shortness of breath, wheezing, skin rash, low blood pressure, high temperature, liver problems, irritation, and confusion.
Shock: Some patients may go into shock during or after surgery. Shock is often caused by excessive blood loss. Shock is a life-threatening condition that occurs when the body's blood pressure is extremely low.
Postoperative Treatment and Rehabilitation
General: Treatment and rehabilitation recommendations vary considerably depending on the type of surgery, as well as the patient's overall health. Patients should always follow their doctor's instructions. A doctor or nurse will go over these instructions with the patient to ensure that the patient fully understands how to care for him/herself. Patients should let their doctors know if they have any questions about their treatments.
General discharge instructions: It is generally recommended that a friend or family member checks in on the patient from time to time during recovery. In some cases, a nurse may be arranged to periodically monitor the patient at home.
The instructions also include how to bathe, clean, and bandage the wound, as well as how to protect the wound from infection.
The instructions will also describe what types of medications to take (if any), as well as how to take them and what not to take them with. Medications that are unsafe to take after surgery are also listed.
The instructions explain how much and what type of physical activity is recommended. The types of foods and beverages that are safe and unsafe to eat during the recovery process are listed.
Directions on how to use medical devices, such as a sling, crutches, or brace, are included.
A list of symptoms that may indicate a medical problem are provided. For instance, a fever, increased pain, and increased drainage from the incision site may be a sign of an infection.
Patients should not stop taking or change the dosage of medications that were prescribed without talking to their doctors first.
Do no smoke: Smoking should be avoided after surgery. Smoking increases the risk of developing a lung infection called pneumonia. It also hinders blood flow and can slow healing.
Walk as soon as possible: Most guidelines recommend that the patient begin walking as soon as possible. Walking increases blood flow and reduces the risk of potentially fatal blood clots, which may develop when a patient is immobile for an extended period of time. Patients who are in the hospital will receive help from nurses, physical therapists, and aids. If the patient is unable to walk, a nurse, therapist, or aid may help the patient move the legs while in bed.
Physical therapy: Some patients may require physical therapy after surgery. The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. For instance, patients who undergo joint replacement surgeries undergo physical therapy to regain use of their new joints.
Follow up with the doctor: Patients should make sure they visit their doctors for follow up exams. When the patient is released from the hospital, the doctor will let the patient know when to come back for medical exams.
If the patient's symptoms change or worsen after surgery, they should visit their healthcare providers immediately.
Note: Many herbs or supplements are considered unsafe when taken before or after surgical procedures. Herbs and supplements can potentially interact with medications, and some therapies may lead to complications, such as increased bleeding. Integrative therapies should only be used after talking to a healthcare provider.
Good scientific evidence:
Colon therapy: Colon therapy is the use of herbs or water to clean out the colon or large intestine to treat certain health conditions. Surgeons or other healthcare practitioners may use colon irrigation before or during some bowel surgeries to cleanse the colon or improve healing.
Excessive treatments may allow the body to absorb too much water, which causes electrolyte imbalances, nausea, vomiting, heart failure, fluid in the lungs, abnormal heart rhythms, or coma. Infections have been reported, possibly due to contaminated equipment or as a result of clearing out normal colon bacteria that destroys infectious bacteria. There is a risk of the bowel wall breaking, which is a serious complication that can lead to septic shock and death. Avoid with diverticulitis, ulcerative colitis, Crohn's disease, severe or internal hemorrhoids, rectal/colon tumors, or if recovering from bowel surgery. Avoid frequent treatments with heart or kidney disease. Colonic equipment must be sterile. Colonic irrigation should not be used as the only treatment for serious conditions. Avoid if pregnant or breastfeeding due to lack of scientific data.
Unclear or conflicting scientific evidence:
Aconite: The aconite plant grows in rocky areas. It is often found in the mountainous woodlands of many parts of Europe, especially France, Austria, Germany, and Denmark. There is limited data on the use of aconite or any of its derivatives in treating pain. Homeopathic aconite may help relieve postoperative agitation, but further information is needed to confirm these results.
Aconite is highly toxic and is not safe for human consumption. Avoid with heart disease, irregular heartbeat, hemodynamic instability (abnormal blood flow), and gastrointestinal disorders, (such as ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, or diverticulosis). Use cautiously with diabetes or suicidal tendencies. Avoid if younger than 18 years old due to a lack of safety evidence. Avoid if pregnant or breastfeeding.
Acupressure, shiatsu: During acupressure, finger pressure is applied to specific acupoints on the body. Acupressure is used around world for relaxation, wellness promotion, and the treatment of many health problems. Several studies report that acupressure provides pain relief to patients after surgeries. This research suggests that acupressure may be as effective as intravenous pain medications. However, further evidence is needed from well-designed trials before a firm conclusion can be drawn.
With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.
Arginine (L-arginine): L-arginine helps maintain the body's fluid balance (urea, creatinine) and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and fights infection. One study suggests that arginine may provide benefits when used as a supplement after surgery. It is not clear what the specific role of arginine may be in improving immune function or what dose is safe or effective.
Avoid if allergic to arginine. Avoid with a history of stroke, liver, or kidney disease. Avoid injections of arginine. Use cautiously if taking blood-thinners, blood pressure drugs, or other drugs, herbs, or supplements with similar effects. Check blood potassium levels while taking arginine. Avoid arginine supplements if pregnant or breastfeeding due to a lack of safety evidence.
Bovine colostrum: Bovine colostrum is the pre-milk fluid produced from cow mammary glands during the first two to four days after birth. Bovine colostrum confers growth, nutrient, and immune factors to the offspring. Bovine colostrum has been studied in individuals undergoing coronary bypass operations, but no benefit was found. Further study is required before a strong recommendation can be made.
Avoid if allergic to dairy products. Use bovine colostrum cautiously because toxic compounds, such as polychlorinated biphenyls (PCBs), dichlorodiphenyltrichloroethane (DDT), and dichlordiphenyldichloroethylene (DDE), have been found in human colostrum and breast milk. Thus, it is possible that these agents may be found in bovine colostrum. Avoid with, or if at risk of, cancer. Use cautiously with immune system disorders or atherosclerosis (hardening of the arteries). Use cautiously if taking medications, such as anti-diarrheal agents (e.g. Imodium®), insulin, or CNS agents (such as amphetamines, caffeine). Avoid if pregnant or breastfeeding.
Chamomile: Chamomile is an herb that is commonly taken as a tea. It is unclear whether or not chamomile spray can prevent post-operative sore throat and hoarseness any more than normal saline.
Avoid if allergic to chamomile or plants in the Asteraceae family, such as aster, chrysanthemum, mugwort, ragweed, or ragwort. Avoid with heart disease, breathing disorders, hormone-sensitive conditions, or central nervous system disorders. Avoid if taking cardiac depressive agents, central nervous system depressants, respiratory depressive agents, or anticoagulants. Use cautiously if taking benzodiazepine, anti-arrhythmic medications, calcium channel blockers, alcohol, sedative agents, anxiolytic medications, spasmolytic drugs, oral medications, or agents that are broken down by the liver. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, and other techniques. It remains unclear if chiropractic manipulative therapy can help treat postoperative atelectasis. Further research is warranted in this area.
Avoid with vertebrobasilar vascular insufficiency, aneurysms, arteritis, or unstable spondylolisthesis. Avoid use on post-surgical areas of para-spinal tissue. Use cautiously with acute arthritis, brittle bone disease, conditions that cause decreased bone mineralization, bleeding disorders, migraines, or if at risk of tumors or metastasis of the spine. Use extra caution in cervical adjustments. Avoid if pregnant or breastfeeding due to a lack of scientific data.
Choline: Choline is an essential amino acid that is produced in the body and consumed in the diet. There is a lack of sufficient evidence to recommend for or against the use of choline in patients recovering from surgery.
Avoid if allergic to choline, lecithin, or phosphatidylcholine. Use cautiously with kidney disorders, liver disorders, or trimethylaminuria. Use cautiously with a history of depression. If pregnant or breastfeeding, it seems generally safe to consume choline within the recommended adequate intake (AI) parameters. Supplementation outside of dietary intake is usually not necessary if a healthy diet is consumed.
Creatine: There is early evidence that heart muscle may recover better and more rapidly after open-heart surgery if intravenous creatinine is administered during the operation. Further study is needed before a recommendation can be made.
The U.S. Food and Drug Administration (FDA) has advised consumers to consult their physicians before consuming creatine. Avoid with impaired kidney function or dehydration. Avoid in combination with ephedra. Use cautiously with diabetes, seizure disorders arrhythmia, deep vein thrombosis (DVT), kidney stones, neuromuscular disorders, or in athletes. Use cautiously if taking caffeine, nonsteroidal anti-inflammatory drugs (NSAIDs), nephrotoxic medications, probenecid, trimethoprim, or cimetidine.
Guided imagery: Guided imagery may involve a number of techniques, including metaphor, storytelling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion. Initial evidence suggests that guided imagery relaxation audiotapes may reduce anxiety after surgeries, and may improve healing. More study is needed before a recommendation can be made.
Guided imagery is usually intended to supplement medical care, not to replace it. Guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset because imagery may trigger these symptoms. Patients who experience feelings of anxiety while practicing guided imagery, or have a history of trauma or abuse, should speak with their qualified healthcare providers before practicing guided imagery.
Healing touch: Healing touch (HT) is a combination of hands-on and off-body techniques to influence the flow of energy through a person's biofield. Data from two small studies are inconclusive as to whether HT can benefit patients with post-operative pain. Studies of better design are needed before definitive recommendations for or against HT can be made.
HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
Hypnotherapy, hypnosis: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Research suggests that hypnosis may be helpful for pain and anxiety in various situations, including after surgery. Early research reports that length of hospital stay and psychological well-being may be improved after surgery with the use of hypnotherapy. However, most studies in this area are not well designed, and updated high-quality investigations are needed before a firm conclusion can be drawn. Hypnotherapy has been used to treat health conditions and to change behaviors.
Use cautiously with mental illnesses (e.g. psychosis/schizophrenia, manic depression, multiple personality disorder, or dissociative disorders) or seizure disorders.
Liver extract: Liver extract and desiccated liver have been marketed as iron supplements for more than 100 years. The extract is processed cow or pig liver that may either be a freeze-dried brownish powder or a concentrated liquid that has had most of the fat and cholesterol removed. Liver extract may help maintain liver function during urological surgery. More research is needed to define the importance of this normalization of liver function.
Avoid if allergic to liver extract or its constituents. In general, liver extract should be used cautiously because raw liver may contain liver flukes or the bacterium, Vibrio fetus. Avoid with iron metabolism disorders or iron shortage disorders, such as hemochromatosis. Avoid liver extract from countries where bovine spongiform encephalitis (BSE or "mad cow disease") has been reported. Use cautiously with clotting disorders, compromised immune function, acid reflux disease, or abnormal iron levels. Use cautiously if taking drugs that affect blood cholesterol, antacids, or antiviral agents (especially interferon, or any agents for cancer). Use cautiously in hepatopathic patients with reduced human growth hormone metabolic clearance rate. Avoid if pregnant or breastfeeding.
Massage: The main goal of massage is to help the body heal itself. Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients. Various massage approaches have been used after surgery with the aim to improve recovery and decrease pain. Further study is needed in this area before a recommendation can be made.
Avoid with bleeding disorders, low platelet counts, or if taking blood-thinners. Areas should not be massaged where there are fractures, weakened bones from osteoporosis or cancer, open/healing skin wounds, skin infections, recent surgery, or blood clots. Use cautiously with a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client.
Nasal irrigation: Nasal irrigation is a technique that is used to clear the sinuses. It can be performed by the patient at home or by a professional up to twice daily. Cleaning of the nose with saline solution after endonasal sinus surgery is very often used for postoperative treatment although the efficiency and acceptance of this method has not been examined thoroughly. There is some supportive evidence that nasal irrigation may help remove infectious microorganisms in postoperative care after nasal (including polypectomy) or sinus surgeries. However, these studies are lacking in the performance or description of statistical analysis. A randomized controlled trial with statistical analysis is needed to reveal further information.
Nasal irrigation is generally well tolerated. Use cautiously with a history of frequent nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injury. A variety of techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used during physical therapy sessions. Physical therapy techniques are often used following cardiopulmonary bypass surgery, abdominal surgery, and other surgical procedures, as well as for the prevention of pulmonary complications. Several studies do not show any difference between various chest physiotherapy treatments, such as incentive spirometry, intermittent positive pressure breathing (IPPB), or deep breathing exercises. Overall, it is difficult to compare treatment outcomes across the various studies and more high-quality studies are needed to make a firm recommendation.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, physical therapy may aggravate some pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Probiotics: Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. Limited evidence suggests a probiotic preparation (VSL#3, containing Lactobacilli, Bifidobacteria, and Streptococcus salivarius subspecies thermophilus) may effectively prevent a complication of gastrointestinal surgery, called pouchitis. This condition occurs when the intestines become inflamed. Notably, discontinuation appears to be followed by relapse, while continuation apparently maintains remission and better quality of life. Lactobacillus GG supplementation, however, has had conflicting results in preventing flare-ups. More studies are needed to arrive at concrete recommendations.
Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant.
TENS (transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. There are multiple controlled studies of TENS for pain following various types of surgery, including abdominal surgery, heart surgery, lung surgery, gynecologic surgery, and orthopedic surgery. Research is inconsistent, with a variety of TENS techniques, patient types, and study designs used. Overall, the quality of available research is poor. Although some studies do report improvements in pain and reduced need for pain medications, a well-designed review in 1996 concluded that there is no clear evidence of benefit. Better quality research is necessary in this area before a strong conclusion can be reached.
Avoid with implantable devices (e.g. defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps). Use cautiously with decreased sensation (e.g. neuropathy) or seizure disorders. Avoid if pregnant or breastfeeding.
Fair negative scientific evidence:
Beta-carotene: Beta-carotene is a member of the carotenoids, which are very colorful (red, orange, yellow), fat-soluble compounds. They are naturally found in many fruits, grains, oil, and vegetables, including green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers. Study results conclude that peri-operative supplementation with antioxidant micronutrients has limited effects on strength and physical function following major elective surgery.
Avoid if sensitive to beta-carotene, vitamin A, or any other ingredients in beta-carotene products. Avoid large oral doses in pregnant or breastfeeding women due to a lack of safety evidence.
Creatine: In two studies investigating the effect of creatine supplementation in individuals undergoing soft tissue surgery, no effect was noted on strength or body composition. Creatine supplementation is likely ineffective given this information and recommendations cannot be made in this field without further study.
The U.S. Food and Drug Administration (FDA) has advised consumers to consult their physicians before consuming. Avoid with impaired kidney function or dehydration. Avoid in combination with ephedra. Use cautiously with diabetes, seizure disorders arrhythmia, deep vein thrombosis (DVT), kidney stones, neuromuscular disorders, or in athletes. Use cautiously if taking caffeine, nonsteroidal anti-inflammatory drugs (NSAIDs), nephrotoxic medications, probenecid, trimethoprim, or cimetidine.
Traditional or theoretical uses lacking sufficient evidence:
Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled, or applied to the skin. Essential oils are usually mixed with a carrier oil (usually a vegetable oil) or alcohol. Although aromatherapy has traditionally been used to enhance recovery after surgery, scientific studies are lacking in this area. Further research is needed to evaluate this use.
Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant. Sage, rosemary, and juniper oils should be avoided if pregnant or breastfeeding.
Ginseng: For more than 2,000 years, the roots of this slow-growing plant have been valued in Chinese medicine. Ginseng has been suggested as a possible treatment after surgery to enhance healing. However, there is insufficient evidence in this area to draw a firm conclusion on ginseng's effectiveness.
Avoid if allergic to ginseng or other plants in the Araliaceae family. Avoid with bleeding disorders, leukemia, or liver disorders. Avoid if taking anticoagulants or anti-platelet drugs. Avoid consuming ginseng in combination with licorice if pregnant or postpartum. Use cautiously with gastrointestinal disorders, high blood pressure, hormone-dependent conditions (such as breast cancer or prostate cancer), sleep disorders, attention deficit hyperactivity disorders (ADHD), irregular heartbeat, heart disease, diabetes, joint or muscle disorders (such as arthritis or fibromyalgia), eye disorders, or psychological disorders. Use cautiously if taking ACE inhibitors, antihyperlipidemics, antineoplastics, cytotoxic drugs, central nervous system stimulants (including caffeine), diuretics, glucocorticoids, HIV protease inhibitors, monoamine oxidase inhibitors (MAOIs), morphine, mitomycin C, sodium channel blockers, nifedipine, agents that increase photosensitivity, or drugs that are broken down by the liver. Use cautiously if undergoing chemotherapy or radiation therapy.
Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually non-directed relaxation. Traditionally, relaxation therapy has been used to reduce anxiety and nervousness before surgery. However, human studies have not been performed to determine if this specific therapy is safe or effective.
Avoid with psychiatric disorders such as schizophrenia/psychosis. Jacobson relaxation (flexing specific muscles, holding that position, and then relaxing the muscles) should be used cautiously with illnesses, such as heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven techniques.
In order to prevent complications of surgery, patients should carefully follow all of their doctors' instructions before and after surgery. Honestly answering all questions about medications, illnesses, and family/medical histories will help the physician make the best recommendations for the patient's treatment.
The U.S. Food and Drug Administration (FDA) recently approved a prescription drug, called the scopolamine patch, to help prevent nausea and vomiting during and after surgery. The night before surgery, the patch is applied to the skin behind the ear. This ensures that all of the medication is absorbed into the body before surgery.
Depending on the type of surgery performed, antibiotics may be prescribed before or after the surgery to prevent an infection from developing.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
American College of Surgeons. www.facs.org.
American Society of Anesthesiologists (ASA). www.asahq.org.
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March 22, 2017