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Surreythoracic.ca

Minimally Invasive Correction of Pectus Excavatum
THE NUSS PROCEDURE
In an emergency please go to the nearest hospital emergency room and have them contact Dr. James Bond or contact the Surrey hospital switchboard at 604-581-2211 to contact Dr. Bond Patients Name: ______________
Date of Surgery:_______________
Date of Pre-admission visit:______________
Restrictions:

- No driving for 6 weeks
- No lifting anything greater then 5 lbs for 2 months
- You may NOT carry backpacks or satchels on your shoulders for 3 months
- You are NOT allowed to sleep on your side or stomach for 4 weeks. Patients often say
that sleeping in a recliner is more comfortable if available
- The only activity you may do for the first 6 weeks following surgery is WALK. -
However, you are not allowed to walk on a treadmill.
- No working out at a gym for adults. This includes aerobics/ pilates/ yoga classes,
biking, running, swimming, elliptical machine, sit ups or weight lifting.
- No flexion or twisting at the waist for 4 weeks
- No slouching or slumping- GOOD POSTURE
Post-operative Milestones:

Week 2-3:
You may return to work as long as you are not taking your narcotic pain medicine or your muscle relaxant. - You may take your steri-strips off your incision. It is also OK to leave them on and allow them to fall off with time. - You may be able to feel or see the bar now that the swelling has subsided- this - You may also have a stitch “spit out” of one of your incisions. This is completely normal and nothing to be concerned about. It will look like fishing wire. Just snip the stitch at the level of your skin and it should retract into the incision and be reabsorbed. - Make follow-up appointment with your surgeon. - You may sleep on your side - You may twist at the waist. - You may drive. - We highly recommend that you begin cardiovascular conditioning such as running, swimming, biking (only if you are skilled), pilates, yoga etc. - We highly recommend that you begin light upper body weight training (no more than 2-5 lbs.) - You may return to contact sports such as basketball, soccer, baseball, etc. - You are restriction free except for the following activities:
3. Wrestling. ** We do not recommend that you participate in any of these activities while the bar is in place in order to decrease the possibility of the bar from shifting.
Things that you need to know:
- We recommend that you buy a medic alert bracelet. The inscription should state the
following: steel bar in chest, CPR more force, cardioversion ant/post placement.
- CPR can be performed; however more force will be needed.
- No MRI’s of the chest and thorax. CT scans are safe.
- Incisional infections generally occur 2 months after surgery. If you notice any redness,
swelling, blisters or pus please contact us immediately.
** Please note that this occurs in less than 1% of the patients, but must be taken VERY seriously and treated immediately. - You will need to make a follow-up appointment with you surgeon approximately 3 weeks after being discharged from the hospital. - You do NOT need to take antibiotic prior to dental work unless you have a diagnosis of mitral valve prolapse. However, during the first 3 months after surgery if you are having major dental work such as extractions or braces applied you will need to be pretreated with an antibiotic this is to be ordered by your dentist. MEDICATIONS:

You will be sent home with the following medications:
1. Narcotic: Dilaudid
a. We expect that you will need to take this for approximately 2 weeks. b. This medication is to be taken only for pain and only as needed. c. As your pain begins to lessen (probably around week 2) we highly encourage you to wean yourself off the narcotic medication. For example, if you have been taking your narcotic every 4 hours we suggest that the next day you try and extend it to every 5 hours and then every 6 hours and so on and so forth until you no longer need it. d. This medication also causes constipation so you must take you Colace 2. Muscle Relaxant: ______________
a. We recommend that you take this in the morning when you wake up and at night before you go to bed. This schedule will help with stiffness. b. This should also be taken for backaches and sudden spasms that feel 3. Advil or Celebrex
a. We recommend that you take this around the clock during the first several weeks for the post surgical inflammation. (dose will depend on your age and size). b. You may need to take this for p to 6 weeks as needed. c. It is necessary that you take this medication with at least 8 oz of water 4. Ativan
a. You may need to take this for 1-2 weeks to help you sleep. (dose will 5. Colace
a. Must be taken while taking narcotic in order to prevent constipation. ** You will be given a month supply of your medications. However, you will probably not need all the medicine that is prescribed nor is it necessary that you finish all the medications. ** We also strongly advise that you do NOT set an alarm during the night in order to wake up and take any medication. It is very important to get a good night’s sleep. Have the medication ready and available if you wake up having pain. FOLLOW-UP APPOINTMENTS

1. A post-operative appointment is to be scheduled at approximately 3 weeks
after you are discharged from the hospital. As stated above you are to see your surgeon.
2. 6 months post surgery appointment:
a. Pulmonary function tests (PFT’s) will be scheduled by the surgeon’s office and completed prior to your appointment. 3. 18 months post surgery appointment:
a. PFT’s will also be completed at this time. 4. Yearly appointments are required until the bar is removed. PFT’s will be

***Please Remember to do your breathing exercises 5 times twice a day AND your
posture exercises daily until the bar is removed. This decreases the chance of your pectus
excavatum reoccurring when the bar is removed.

Source: http://www.surreythoracic.ca/_docs/NussProcedureInfo.pdf

Pii: s1369-5274(02)00280-10

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