Guide to Orthopaedic & Neuromuscular Surgery

Preparing for Surgery

Optimizing Your Child’s Health

It is vital that your child comes in for surgery feeling their best. Preparing your child’s health prior to surgery helps their outcomes and eases the recovery process. We may help optimize your child’s health in a few ways:

Assess Vitamin D levels and nutritional status: This assessment helps ensure that your child’s nutritional status helps them heal after surgery. Studies have shown that normal vitamin D levels can reduce the risk of fractures and improve fracture healing.
Obtaining clearance from other specialists: Meeting with your child’s entire healthcare team allows a multidisciplinary approach to your child’s care before, during, and after surgery. We may ask you to see your other providers for clearance and for advice on how best to care for your child during their surgical journey.
Pain management with Gabapentin: Your surgeon may prescribe Gabapentin the week prior to surgery to reduce the excitability of nerve cells (neurons) in the brain, which play a role in the transmission of pain signals – nerve pain. Starting this medication the week prior to surgery allows for full effectiveness by the time your child has surgery – they will continue this medication after surgery to help control nerve pain.
Arranging post operative referrals for physical therapy, transportation, and other essentials for a smooth post operative course: Scheduling post operative appointments, medical equipment, paperwork can all be addressed at your preop visit. This allows you and your family to focus their attention on your child while we get these necessary items in order.

Preop Planning and Tour

Anxiety and fear of the unknown is totally normal; for both you and your child. Be honest with your child at an age-appropriate level about their upcoming surgery and share your concerns with members of your care team – they are all there to support your child and your entire family through the perioperative process. Tips for Talking to Kids about Surgery can help you get started having conversations with your child. For additional questions or support, call the Child Life Specialist at 858-576-1700 ext. 223321.

Preop Tours are given every Wednesday evening from 6:30pm–7:30pm. Please pre-register by the Tuesday prior if interested. Visit the Preop Tour page to register or to watch videos and educational resources to prepare you and your child for surgery.

Diet and Eating Restrictions

Your child will need to stop eating before their procedure to minimize the possibility of vomiting and respiratory problems before, during, and after anesthesia and surgery. The procedure may be canceled or delayed if your child eats or drinks past the scheduled time. Your supervision is very important. Click below for a guide on eating and drinking instructions prior to surgery.

Eating and Drinking Instructions Guide – English | Spanish

Illness

Please call the doctor’s office BEFORE the procedure if your child has symptoms such as fever, cough, runny/stuffy nose, diarrhea, vomiting, rash, or if they recently visited urgent care or were exposed to contagious diseases.

Medications

Do not give medications containing aspirin or ibuprofen for two weeks prior unless instructed by your doctor.
If prescribed Gabapentin, ensure it is taken as directed.

Bathing and Hygiene

Bath/shower your child the day before or morning of surgery. DO NOT clip hair or overly scrub skin.
Wear clean pajamas or clothes. Nail polish, makeup, and jewelry should be removed.

What to Bring to Hospital

Medications (including herbal), comfort items, ID and insurance cards, physician paperwork.
Payment/co-pay, court documents (if applicable), home medical equipment.

Transportation and Visitors

Your child must be accompanied by a parent/legal guardian. Arrange private transportation in advance. All patients must have an adult present to bring them home. Siblings and additional visitors should stay home.

What to Expect From Surgical Procedures

Below is a list of resources for specific surgical procedures. Click below to learn more about each procedure as well as what to expect from recovery.

The Day of Surgery

Arriving at the hospital/check in

Please arrive at the Warren Family Surgical Center – Acute Care Pavilion, 1st Floor at 3010 Children’s Way, San Diego, CA 92123 at the time provided during your preop call. If driving, park in the “South Parking – Visitor Garage” across from the hospital. Check in at the lobby desk, and they will direct you to the surgical check-in area.

Once checked in, you and your child will be registered and brought to the preop area. Your child will change into hospital PJs, meet their anesthesia and surgical team, and review the hospital journey. Your surgeon will also meet you here, review the plan, and answer any last-minute questions before obtaining your consent.

During Surgery

Your child will be made comfortable and transferred to the operating room. Parents are not allowed in the OR. You will wait in the family waiting area and be updated throughout the procedure by a nurse liaison. This is a good time to eat, rest, and recharge.

Some surgeries may require a blood transfusion. Blood transfusion is safe and effective. More information is available at Rady Children’s Blood Transfusions.

After Surgery

The surgeon will meet you in a consult room once the procedure is complete. Meanwhile, your child will be brought to the Post Anesthesia Care Unit (PACU) to fully wake up. Once stable, you will be called to join your child. They will then either be discharged, transferred to an inpatient unit, or to the ICU depending on their needs.

Inpatient unit

Your child may stay overnight (or longer) for pain management and to begin physical therapy. You may stay overnight with your child. We recommend limiting visitors and keeping siblings at home to reduce infection risk. You’ll receive more information from staff and the ‘Partners in Care’ program during your stay. Partners in Care.

Discharge

When your child meets the discharge criteria, a nurse will meet with you to review home care instructions and complete paperwork.

At Home

Pain management/medications

It is normal for your child to have some pain after surgery. You will be discharged with prescriptions for:

Ibuprofen (Motrin) – for pain and inflammation
Acetaminophen (Tylenol) – for mild pain
Diazepam (Valium) – for muscle spasms
Oxycodone – for severe pain
Gabapentin – for nerve pain, if continued post-op

Apply ice for 20 minutes on and 20 minutes off, with a barrier between skin and ice (do not apply to casts). Elevating your child’s extremity can reduce swelling and ease pain. Keep all medications secure at home and dispose of any leftover narcotics safely. Medication safety resources

When to call

Is in extreme pain not relieved by prescribed medications
Is unable to sleep, is screaming, or seems extremely uncomfortable
Reports numbness or burning inside their cast

Call nurse triage (M–F, 8am–4:30pm): 858-966-1700 ext. 226014
Call the on-call ortho doctor (after hours/weekends): 858-966-1700

Incision sites

Keep incision areas clean and dry. Call immediately if you notice:

Increased redness, heat, or swelling
Drainage from the incision
Your child develops a fever

Cast Precautions

Check your child’s fingers or toes regularly. Contact us immediately if you notice:

Color changes or slow capillary refill
Numbness, tingling, redness, or sores at cast edges
The cast feels too tight or too loose
An extremely foul odor
The cast gets wet or something falls inside

DO NOT get the cast wet. No baths or showers—sponge baths only. Do not use powders, oils, or creams near the cast edges. Never place objects inside the cast. For itchy skin, try blowing cool air into the cast or tapping on it externally for relief.

Nurse Assistance

Claire Burke, RN, BSN, CNOR, is the nurse specialist for Dr. Curran and Dr. Thompson. She can assist with questions, paperwork, referrals, orthotic and physical therapy coordination, and can relay messages to the doctors.

You can reach Claire via MyChart or by calling 858-966-1700 ext. 227284. She typically responds within 48 hours or sooner.