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Postoperative care

Postoperative care

Observation after surgery

These are the conditions that may warrant admission after surgery:

  • Uncontrolled postoperative pain that requires intravenous pain medications
  • Abnormal vital signs such as fever and low blood pressure
  • Vomiting that requires intravenous anti-emetic
  • Postoperative bleeding
  • Significant distance to home
  • Additional medical conditions such as respiratory distress
  • Feeding difficulties – Your care team will let you know if you will be admitted for diet progression prior to discharge

If your child does not have any of the concerns above, your child may be released home directly from the recovery area

At home after surgery

General

  • It's not uncommon for some children to feel fussy, uncomfortable and disoriented after surgery from the general anesthesia but this usually resolves after 8 to 12 hours.
  • Many children also may not have an appetite until the morning after surgery, however, most of the time children can restart their postoperative diet as tolerated.

Pain control

  • There are the most commonly used medications to control your child's pain from surgery: acetaminophen (Tylenol), ibuprofen (Advil) and narcotics such as Hycet (hydrocodone-acetaminophen). Other alternate options are lidocaine patch and gabapentin.
  • We recommend that you first try acetaminophen and ibuprofen before trying any narcotics. Of note, some narcotics such as Norco and Hycet contain acetaminophen and thus should not be given within 4 hours after giving acetaminophen. 
  • Your child may receive a dose of gabapentin 1 hour before surgery and scheduled doses of gabapentin every 8 hours for 48 hours after surgery. For additional pain control, we also recommend placing an over-the-counter lidocaine patch over the gastrostomy site. This patch should be changed every 12 hours and may be used for 48 hours after surgery.
  • When is pain concerning? If those medications do not control the pain even after you have given them sufficient amount of time to work (1 to 2 hours),please give us a call or call the hospital to page the physician on call. During regular hours and after hours, our number is 804-828-3500. Postoperative pain may worsen 4 to 6 hours after surgery as the local numbing medication and intravenous medicines wear off. Pain may worsen after physical activities. However, the pain should improve gradually.

Vomiting

  • Your child will be prescribed ondansetron (Zofran) to go home with. Please give it to your child when your child is nauseated and/or vomits. If the nausea or vomiting persists despite the medicine, please hold the tube feed for 2 hours and restart it once it improves. If vomiting persists, please call the provider on call.

Hygiene

  • Please only take sponge baths for 2 days after surgery and then they can take full baths.
  • For the first 2 days, please change the split gauze under the G-tube at least every 8 hours or as necessary to keep the skin dry. Please refer to G-tube care for step by step instruction on how to do this.

Physical activities

  • Please resume light activity for 2 days after surgery.
  • Most children can return to school or day care and resume normal activities several days after surgery.

Telemedicine

  • You may be sent home with a tablet or asked to install the VCU Health Anywhere application on your computer to follow up with us closely at home.
  • This will be arranged with your surgeon before the surgery. You will be provided with explicit instructions as to how to use them and when to follow up with us (likely few days after surgery).