Trans-sphenoidal Post-Operative Instructions

What Can I Expect After A Trans-sphenoidal Pituitary Adenoma Resection? 

Nasal Cleaning: Nasal rinsing must begin the day you are discharged from the hospital and performed at least twice a day. A Neilmed® rinse bottle may be purchased at any drug store or pharmacy. Please make sure you buy the box with the pre-mixed packets. Follow the instructions provided in the Neilmed® package. 
Nasal Congestion: It is normal to have nasal congestion due to swelling that occurs after surgery. Performing the twice daily nasal rinses can help relieve some of the congestion, but will not totally eliminate it. You may have a nasal splint in each nostril which will also contribute to the feeling of congestion. 
Nose Blowing and Sneezing: Avoid nose blowing until cleared by your healthcare team. If you have to sneeze/cough, do it with an open mouth. 
Nasal Discharge: It is normal if you have blood tinged mucous drainage for up to several days after your surgery and some minimal nasal bleeding. If the bleeding does not stop, call your healthcare team or go to the nearest emergency room. Also, if you have clear fluid that continues and does not stop, call your healthcare team. 
Smell: Your sense of smell will decrease after surgery and may take up to a few months to return. It is normal to have a bad breath (halitosis) during recovery due to nasal discharge and crusting. 
Head elevation: Try to keep your head elevated as much as possible for the first 24 to 48 hours. 
Headaches: Headaches are common. You may continue to take you take prescribed medicine for headaches if needed. If you have a very severe, non-stop headache along with nausea or vomiting, call your healthcare team. 

It is common to feel tired after surgery.

Thirst: It is normal to have increased thirst. Drink plenty of water. 
Sore throat: You may have a sore throat or hoarseness for several days after surgery. This is generally due to the breathing tube that was inserted into your airway during surgery. This should resolve in a couple of days. You may use throat lozenges as needed to help with the discomfort. 
Nausea: Nausea is common after surgery and is related to the anesthesia. This should resolve in 1-2 days.
Diet: You may resume your normal diet and fluid intake. To help prevent constipation, add more fibers to your diet.
Activity: Avoid heavy lifting (over 20 pounds), strenuous activity or bending over until cleared by your healthcare team. Continue light daily walking. 

How Will I Manage My Pain At Home? 

It is normal to have mild to moderate pain/discomfort at the surgical site. If you are given a prescription for a narcotic pain medicine, such as Tylenol® with codeine or Percocet®: 

  • Do not drink alcohol 
  • Do not drive 
  • Do not take more than prescribed 
  • Do not combine with additional narcotic pain medicines 
  • Do not take additional Tylenol®/acetaminophen while taking Tylenol® with codeine or Percocet.  

Narcotics cause constipation. To help avoid constipation, take Colace® (stool softener) twice a day (available over the counter at pharmacies) or supplemental fibers. If you do not have a bowel movement with Colace®, you may also need a laxative such as Miralax® or Milk of Magnesia. 

Narcotics will be tapered off over days to weeks as you recover. 

If you are not given narcotic pain medicines, you may use over-the-counter acetaminophen (Tylenol®). Do not take ibuprofen, Aleve®, Advil®, aspirin, Motrin® or other non-steroidal anti-inflammatory (NSAID) pain medicines as these may cause bleeding.

What Can I Expect When I Am Discharged? 

Do not return to work or school until you are cleared by your healthcare team. 

When Should I Call My Healthcare Team? 

Please call 732-235-2465 if you have:  

  • Increased shortness of breath or difficulty breathing 
  • Temperature of 100.4° F or higher 
  • Heart palpitations or chest pain 
  • Increasing drainage or foul odor from your nose 
  • Drainage of blood or pus from the wounds  
  • Worsening or severe headache 
  • Any pain that is not relieved by your pain medicine 
  • Significant bright red bleeding from your nose
  • Any other symptoms you find concerning 

Please follow up with your healthcare team in 2 weeks for evaluation. Please call 732-235-7615 to schedule an appointment. 

Important Phone Numbers 

After hours, weekends and holidays: 732-235-2465
Appointments 732-235-7615 
Surgical Scheduler 732-235-8901
If you are having problems during business hours (8:30 a.m. to 5:00 p.m.), please call (732) 235-2465 and the operator will direct your call. If it is after business hours, on a holiday or weekend, please call the same number and our answering service will assist you.

Download a printable version of the Trans-sphenoidal Post-Operative Instructions

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