Melbourne Hand Surgery 

Please note: Due to high demand our next new patient appointment at Melbourne Hand Surgery is in 4 months. There are no further appointments available in 2018 unless existing booked patients cancel.So we can streamline your care and ensure that urgent and emergency conditions are seen in a timely manner we require that all patients provide a referral from their general practitioner prior to seeking an appointment date. Once we have received your referral we will contact you to schedule an appointment. Referrals can be submitted by secure messaging (Argus, HealthLink, MedicalObjects), email, mail or fax.  

Melbourne Hand Surgery closes for the holiday season at 5pm on Monday 17 December 2018; we will resume consulting and operating on Monday 14 January 2019.

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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