Melbourne Hand Surgery 

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Latest news: Elective hospital surgeries are now unrestricted and we have options to book prior to Christmas. You no longer need to have a COVID test prior to hospital admission. Dr Tomlinson is operating at The Avenue and Glenferrie Private; Epworth Cliveden is indefinitely closed at this time. Our offices will be closed from 21 December 2020 until 10 January 2021 inclusive.

All suitable consultations at Melbourne Hand Surgery are currently conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. We have implemented enhanced hygiene measures in our rooms including acrylic screens, masks, hand sanitiser, face shields and physical distancing-related changes. We require that all patients provide a referral prior to booking an appointment so that urgent and emergency conditions can be identified and managed in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation.

Victorians are in this together and together we will get through this. Thank you for your understanding as our community works through these unprecedented times together (last updated: 24 November 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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