Preparing for Hand Surgery

Before surgery — the weeks ahead

Smoking, vaping, and nicotine

Nicotine in any form (cigarettes, vapes, patches, gum, chewing tobacco) constricts the small blood vessels that tissues need to heal. For any soft-tissue, bone, or flap surgery, ideally stop all nicotine 4 to 6 weeks before surgery and do not use any until at least 6 weeks afterward. For vascularized bone flap and free-flap surgery, this is a strict requirement — the surgery can fail without it.

Medications to adjust

• Blood thinners (warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel). Do not stop these on your own. We will coordinate a plan with the prescribing doctor. Some need to be stopped several days before surgery; others are managed with a "bridge."
• Aspirin. Usually continued if you take it for a heart or stroke history. Ask us at your pre-op visit.
• Ibuprofen, naproxen, and other NSAIDs. Stop 5 to 7 days before surgery to reduce bleeding unless we say otherwise.
• Rheumatoid medications (methotrexate, biologics). Discuss with your rheumatologist; timing depends on the specific medication.
• Diabetes medications. Usually held or reduced the morning of surgery because you will not be eating. Your diabetes doctor or our office will give specific instructions.
• Weight-loss and diabetes injections (semaglutide, tirzepatide, etc.). Usually held for a week before surgery because they slow stomach emptying.
• Herbal supplements. Many (ginkgo, fish oil, garlic, ginseng, vitamin E) increase bleeding. Stop all supplements a week before surgery unless we say otherwise.
• Birth control pills and hormone replacement. Usually continued; we will let you know if yours should be paused.

Health check

• If you have a cold, flu, fever, or active infection (skin, urinary, dental) in the week before surgery, call us — the procedure may need to be rescheduled.
• Keep the skin on the operative arm intact. Treat any cuts, rashes, or athlete's foot well in advance. Avoid new tattoos on the arm in the weeks before surgery.
• Regular exercise, good sleep, and a balanced diet in the weeks before surgery help recovery.
• If you have poorly controlled diabetes, high blood pressure, sleep apnea, or other chronic conditions, work with your primary care doctor in the weeks leading up to surgery to get them into the best shape possible.

The day before surgery

• Confirm your arrival time with the surgical facility (it often changes the day before).
• Wash the operative arm with regular soap in the shower. You may be given an antiseptic wash (chlorhexidine) to use the night before and the morning of surgery.
• Remove nail polish and acrylic nails on the surgical hand (we need to see the fingernail color as a monitor during surgery).
• Remove rings and bracelets from the surgical arm before surgery day — swelling can make them impossible to remove later.
• Set up a "recovery corner" at home: a reclining chair, pillows for elevation, a table for drinks and medications within reach, and things you will want in the first day or two (books, a charger, a remote).

Eating and drinking rules (NPO)

"NPO" means nothing by mouth. Following these rules prevents dangerous complications during anesthesia.

• No solid food for 8 hours before arrival time. This includes gum, mints, candy, and small snacks.
• Clear liquids (water, black coffee with no milk, plain tea, apple juice, broth) are usually allowed up to 2 hours before arrival. Confirm the exact cutoff with the surgical facility.
• No milk, juice with pulp, smoothies, or alcohol on the morning of surgery.
• Medications. You will be told which of your regular medications to take the morning of surgery with a small sip of water.

The day of surgery

What to bring

• Photo ID and insurance card
• A list of your current medications and allergies
• Your CPAP machine if you use one at night
• A case for your eyeglasses, hearing aids, or dentures (we will ask you to remove them before surgery)
• Comfortable, loose-fitting clothes with wide sleeves so clothing can slide over the surgical dressing afterward
• A responsible adult driver to take you home. You cannot drive yourself or use a rideshare alone, even for local anesthesia cases, if you received any sedation.

What to leave at home

• Valuables, jewelry, and large amounts of cash
• Contact lenses (wear glasses instead, in a case)
• Makeup and lotions on the operative arm

What to expect at the facility

1. Registration. You check in and complete paperwork.
2. Pre-op holding. You change into a gown, an IV is placed, and the surgical team reviews your chart, medications, allergies, and the planned procedure. Dr. Barrera will come see you, confirm the surgical site, and mark the arm with his initials.
3. Anesthesia. Most hand surgeries are done with regional anesthesia (a nerve block that numbs the entire arm) plus IV sedation, or with general anesthesia. The anesthesia team will discuss the best choice for you. The nerve block will be placed in the neck or armpit region with ultrasound guidance and typically lasts 12 to 24 hours afterward, helping with pain control.
4. Surgery. Most hand procedures take 30 to 90 minutes; some complex reconstructions are longer.
5. Recovery room. You wake up with the dressing already applied. The nurses monitor you, give you something to eat and drink, and once you are stable you are discharged home.

Understanding the nerve block

• A regional nerve block numbs the arm from the shoulder down and lasts typically 12 to 24 hours.
• The arm will feel heavy, limp, and completely numb during that time. This is expected and is not a complication.
• Because the arm has no protective sensation, you must keep it in a sling or resting on a pillow. Do not expose it to heat (hot water, heating pad, stove, hot car) while numb — you will not feel a burn.
• Start oral pain medication before the block wears off. As the block fades you will begin to feel sensation returning ("pins and needles"). Do not wait for pain to start before taking your pain medicine; take it on schedule during that first day so the transition is smooth.

Setting up your recovery at home

• Elevate, elevate, elevate. Set up pillows so that the hand naturally rests above the heart. A reclining chair or a couch with several pillows is ideal for the first 3 to 5 days.
• Ice on standby. Have an ice pack (or a bag of frozen peas) ready. Ice over the dressing 20 minutes on, 20 off, for the first 2 to 3 days.
• Groceries and meals. Stock up on easy-to-prepare food a few days before. You will likely be one-handed for the first few days.
• Help with daily tasks. Plan to have someone help with bathing, dressing, cooking, and driving for the first 24 to 72 hours, especially after larger procedures.
• Childcare and pet care. Arrange coverage — you cannot lift a toddler or walk an unpredictable dog safely after most hand operations.
• Pharmacy. Fill any prescription medications the day before surgery. Have Tylenol and ibuprofen on hand (if safe for you) and an antacid if you are prescribed anything that may upset your stomach.

Follow-up and communication

You will typically have a wound-check appointment 10 to 14 days after surgery. For non-urgent questions, call the office. For urgent concerns after hours, the answering service will reach the on-call surgeon.

Related

Cast & splint care · Home hand therapy · Returning to work after hand surgery

Questions?

Call your office location for non-urgent questions:

• NYU Langone Laurelton · 646-501-4950
• NYU Orthopedic, Woodside · 929-429-3222
• NYU Orthopedic, Richmond Hill · 718-206-6923
• Jamaica Hospital Ambulatory Care Center (ACC) · 718-301-0720

See our office contact information for addresses and fax numbers.