Melbourne Hand Surgery 

Coronavirus update: All suitable consultations at Melbourne Hand Surgery are now conducted via telehealth (phone or video consultation). Emergency and urgent surgery is currently being conducted in hospitals and we anticipate a return to full elective surgery services from 31 July, in line with Victorian Government directives on the staged recommencement of elective surgery. We are applying the same timing to the recommencement of elective rooms procedures. 

Our practice will be closed on Fridays until further notice. We will use this website banner to provide general updates on changes to our practice and the availability of procedures and surgery. Thank you for your understanding as our community works through these unprecedented times together (last updated: 26 June 2020).

Rheumatoid arthritis, medications and surgery

 

capsules 200x150Decisions to stop or continue medications before or after surgery need to take into consideration your medical conditions as well as the type of surgery. For minor procedures that are performed under local anaesthetic there is usually no need to stop regular medications for rheumatoid arthritis, but for larger procedures it may be recommended to stop the medication prior to surgery and recommence it once your wounds have healed (usually 2 weeks after surgery). Current evidence suggests:

Medication Perioperative management
NSAIDs Continue for hand surgery unless unusually high bleeding risk exists
Methotrexate Continue
Sulfasalazine Insufficient data
Azathioprine Insufficient data
Cyclophosphamide Insufficient data
Cyclosporine Discontinue 3-4 days before surgery, recommence after wounds have healed
Hydroxychloroquine Discontinue prior to surgery; recommence after wounds have healed
Penicillamine Discontinue on day of surgery, recommence after wounds have healed
Leflunomide® Insufficient data
Infliximab® Insufficient data
Etanercept® Insufficient data
Adalimumab® Insufficient data
Hydrocortisone Continue
Prednisolone Continue
Methylprednisolone Continue
Dexamethasone Continue

Reference

Thorsness RJ, Hammert WC. Perioperative management of rheumatoid medications. J Hand Surg AM 2012; 37A; p1928-1931

 

FRACS

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