Melbourne Hand Surgery 

Please note: We do our best to accommodate emergency and urgent referrals upon receipt of your doctor's referral. Dr Tomlinson is currently booked some months in advance so if your condition is urgent or you wish to be placed on our "Waiting for an Early Appointment" list to see Dr Tomlinson or Mr Babazadeh please provide us with your doctor's referral and your registration forms so that we can facilitate an urgent review. We strongly encourage individuals who are seeking non-surgical treatment of Dupuytren's contracture with Dr Tomlinson to seek placement on our waiting list and provide us with details of your availability, so that we can contact you in the event of an earlier appointment becoming available. If you have recently sustained a hand or wrist injury you may wish to explore the option of the Action Rehab Urgent Care Clinic, where your injury will be assessed and managed by an experienced hand therapist.

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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