How Should I Sleep After Hand Surgery?

Woman holding hand following surgery.

The first and best way to stay comfortable after hand and wrist surgery is to fully understand the human body’s response to the surgery itself. Our cells, nerves, tendons, and muscles see and respond to surgical procedures in the same way they respond to an accident or injury.

Your Body’s Response to Surgery

So although your orthopedic hand surgeon is highly trained and experienced in fixing whatever problem you have (for example, a compressed nerve, arthritis, tendonitis, or broken bone) while exposing you to the least risk possible, the surgery itself involves making an incision, moving and retracting tissues and usually removing or cutting bone or tissue.

Even though it is performed in a sterile environment by a highly trained individual, the human body’s natural defense mechanisms and immune cells still see the procedure as something “abnormal.” They see that the skin has been cut and previously undisturbed structures have been moved and manipulated.

This always triggers a mild inflammatory response consisting of some degree of swelling, redness, and discomfort. In fact, the first phase of wound healing that every surgeon learns about in medical school is called the “inflammatory” phase. This phase is important, not only to provide continued protection against infection but also to ensure that all the right cells are called to the site of the surgery to rebuild tissues to complete the healing process.

Therefore in the first nights and days after your surgery, you can and should expect some amount of swelling, redness, and discomfort. Keep in mind that this response is different in different patients. If you have friends or acquaintances who have had the same surgery but seem to feel more or less pain, this is nothing to worry about.

Having correct expectations before the surgery about pain and swelling will help the healing process proceed more comfortably.

How to Deal With Inflammation

The first simple thing to do in the inflammatory phase after surgery includes elevating the operated hand/wrist above the level of your heart. A simple way to think about this is to create a “downhill path” for blood and fluid to move from your fingertips to your heart using only gravity. Your surgeon might teach you the “hand above elbow, elbow above heart” rule.

When sleeping, it may help to use a large mound of pillows, either beside you or on your chest, to keep your hand and wrist in this elevated position. Activities during the day that require a lot of standing and holding the hand and wrist where it would normally be (below the level of the heart) will probably contribute to more swelling and increased pain levels.

The second intervention is to use ice. Keeping the operation site cool with a bag of ice will help to calm the inflammatory response somewhat and lower pain levels by dulling the pain signals sent to your brain.

It is important not to place the ice directly on the skin, as prolonged exposure may cause frostbite, so consider wrapping a bag of ice in a thin towel. If you have a splint or bulky dressing on, it is still recommended that you use ice as long as you keep your splint or dressing completely dry.

The third intervention is gentle movement of the fingers. It is very important to clarify with your surgeon if this is permitted because moving the fingers after certain procedures can cause damage or increase the risk of complications. If movement is permitted by your surgeon, he or she will likely leave them free, outside your surgical splint or dressing.

Gentle motion involves straightening your fingers and slowly bending them down towards your palm. This motion will help to “pump” extra fluid and blood away from the operative site and back towards your heart, thereby helping to minimize swelling. You should never perform active gripping or lifting with the involved hand after surgery unless your surgeon tells you it is permitted.

Controlling Postoperative Pain After Hand Surgery

Finally, your surgeon will discuss postoperative pain control with you. The simplest way to approach pain control is to first make sure you are doing all three steps listed above:

  • Elevation
  • Ice
  • Gentle motion

If after these you are still experiencing too much discomfort, you may consider taking pain medication as prescribed. Some surgeons, especially hand surgeons, may discuss a “step-wise” approach to pain control, beginning with gentle anti-inflammatories and painkillers such as ibuprofen(Advil) and acetaminophen (Tylenol) that have been proven very effective and with minimal side-effects.

If doses of these medications do not serve to reduce pain to a comfortable level, a narcotic prescription may be used. It is important to keep in mind that narcotic medications are known to cause serious side effects in many patients. These side effects may include:

  • Delirium
  • Respiratory depression
  • Nausea
  • Vomiting
  • Constipation 

During the first few nights after surgery, consider taking a dose of ibuprofen or acetaminophen right at bedtime, and set an alarm to take another dose in four to six hours. Many patients notice that they are able to fall asleep because they remain “on top” of their pain during the day, only to awaken in the middle of the night with increased discomfort that may take one to two hours to bring back to normal levels.

Setting an alarm and taking medication prior to the onset of this discomfort will help you achieve the most restful night possible.

But by far the most important thing contributing to a comfortable night’s rest after hand surgery is having appropriate expectations and a positive outlook! Understanding the healing process is the best way to do this, and keeping in mind that any discomfort you feel after surgery is only temporary. Know that your healthcare providers are here to assist you to get back to the life you have always wanted to live!

Do You Have Questions About Hand Surgery?

We realize that you may have a lot of questions about hand surgery, including how it is performed, when you might need it and if it is right for you. Please contact us. We’ll be glad to answer any questions you have.