Enhanced Recovery After Surgery (ERAS)

Total Shoulder Arthroplasty ERAS

Appointment New Patient Appointment or 214-645-8300

Goals

The objectives of our Enhanced Recovery After Surgery (ERAS) programs are to:

  • Make this an ideal surgical experience for you, the patient.
  • Incorporate innovative pain medications to improve your postoperative pain control while decreasing your narcotic needs.
  • Prevent potential surgical and anesthesia complications.
  • Reduce the amount of time you are in the hospital with the goal of discharging you home the same day of your surgery.
  • Decrease the likelihood of having to return to the hospital after discharge.
  • Accelerate your functional recovery.

Before Surgery

  • Your surgeon will meet with you to explain surgical plans and set expectations for your surgery.
    • Contact your surgeon via MyChart or call the Orthopaedic Clinic with questions: 214-645-3300.
  • You will receive instructions for surgery and medications via a phone call before surgery. You may also be scheduled for an appointment in our Pre-Surgical Testing Clinic to meet with our anesthesia team and have bloodwork drawn.
    • We may request testing or records from your other physicians.
    • Call our Pre-Surgical Testing clinic with any questions: 214-645-4120.
  • Lifestyle change recommendations:
    • We encourage you to stop smoking two months before surgery. We encourage you to stop consuming alcohol for one month before surgery.
    • You will receive specific instructions regarding exercises to do at home.
    • Eat a balanced, healthy diet high in protein and remain hydrated throughout the months and weeks leading up to surgery.
  • Three days before surgery:
    • Apply mupirocin nasal ointment (betadine swabs if allergic to mupirocin).
    • This is done to minimize the risk of infection.
  • On the night before surgery:
    • Eat no solid foods after 11 p.m.
    • Shower with Hibiclens (which you will receive at your clinic visit).
    • You can drink clear liquids (such as water, Gatorade, or black coffee) until two hours before your surgery start time.
  • On the day of surgery:
    • Shower with Hibiclens.
    • Drink either a bottle of water or 20 oz. of Gatorade on the way to the hospital, at least two hours before your surgery start time.
    • In the pre-op area, you will receive non-narcotic pain medications (celecoxib and acetaminophen) to reduce your postoperative pain. If you are at high risk for nausea, you may be given medicines before surgery to decrease this risk.
    • The majority of patients receive a nerve block before surgery. The nerve block uses local anesthetic to decrease your pain after surgery.

During Surgery

  • You will receive general anesthesia.
  • Your anesthesia team will monitor you very closely during the surgery.
  • You will receive medications during surgery to treat pain and nausea.
  • There will be a specific and tailored anesthetic protocol to decrease the stress on your body, improve pain, and accelerate your recovery.

After Surgery

  • You will wake up in our Post-Anesthesia Care Unit (PACU).
  • The nerve block numbs the nerves that provide pain sensation from the area of the surgery and additional nerves that are located nearby. One of those nerves is a nerve that goes to the diaphragm and helps you breathe in. People with lung problems, or who are very observant, may notice some shortness of breath. This is typically not a problem and will resolve when the shoulder numbness resolves. If your oxygen levels are safe in the recovery room, you are safe to go home. If you wear a CPAP or BiPAP, please wear it when you sleep for the next three nights. If you feel short of breath when lying flat, sitting up some when sleeping can help.
  • Use your incentive spirometer tool to expand your lungs.
  • Avoid other local anesthetic numbing medications for the next four days.
  • Home exercises and physical therapy will be an essential part of your recovery regimen. You will start the exercises when you go home.
  • Unless instructed otherwise by your nurse or surgeon, you should be able to eat a normal diet a few hours after surgery.
  • You will take scheduled non-opioid pain medications during your recovery and have narcotic medications available for breakthrough pain, if necessary.

Important Contact Information

  • Pre-Surgery Testing Clinic: 214-633-4202
  • Orthopaedic Clinic:
    • Dallas location: 214-645-3300
    • Richardson/Plano location: 214-645-4116
  • Anesthesiology website