Care After Multi-Level Surgery (SEMLS)

Physical therapy is an important part of recovery after a single event multilevel surgery (SEMLS). Here is an overview of the stages of rehabilitation you might expect.

• Acute inpatient: Your child will stay at the hospital after surgery to make sure their pain is under control, and they can be transferred from one spot to another safely. They may need help transferring from their bed to their wheelchair/crutches or from their wheelchair/crutches to the toilet. The number of days in the hospital depends on your child’s procedure and recovery.
• Early post-operative: After leaving the hospital, your child may have activity restrictions that are determined by the surgeon and your child’s care team. During this time, you and your child will work on range of motion and pain control in order to get ready to start intensive rehabilitation.
• Intensive rehabilitation: This typically starts 6 weeks after surgery. Your child will begin intensive therapy, which can include physical and occupational therapy depending on your child’s needs. This can happen in the inpatient rehabilitation unit or outpatient with therapy up to 3 times per week.
  
  • An inpatient rehabilitation stay is typically 1 to 2 weeks. The duration is determined by the rehabilitation team. Your child will have outpatient therapy following their stay in the hospital.
  • The higher frequency of outpatient therapy is typically for 3 months.
• Late post-operative: After your child completes the intensive physical therapy, they will need to continue with stretching and strengthening. Physical therapy is typically continued less often than during the intensive rehabilitation phase. This is to make sure your child gets the most benefit from surgery.

Following a SEMLS procedure, your child will be on medication to help relieve pain. The next is a review of the types of pain your child may have after surgery and the pain medications we may recommend to help with this pain.

• Acute pain: This type of pain is caused by an injury or surgery. It is short-term and will stop once your child has healed from their injury or surgery. If your child had bone surgery, we expect them to have acute pain for about 2 to 3 weeks. If your child had soft tissue releases, we expect them to have acute pain for about one week. We use oxycodone, Tylenol and Motrin to help relieve acute pain. Each medication works on pain in different ways in the body. Oxycodone and Motrin should be given with food to avoid gastrointestinal symptoms.
• Nerve pain: Nerve pain is caused by irritation of the nerves during surgery. The nerves can be stretched during surgery after the muscles are lengthened. The nerve is now in a new position, and this can cause pain. While your child is in the hospital, we will focus on positioning to help prevent nerve stretch and reduce discomfort. Changing your child’s position frequently (called “positioning”) can help them stay comfortable and keep their skin healthy. The pain felt from nerve stretch can feel like burning, stabbing, tingling or numbness. We use gabapentin or Lyrica for this type of pain. Gabapentin and Lyrica can take up to one month to reach their full effect. If your child is having nerve pain, we will start at a low dose which can be increased as needed. Typically, this medication needs to be taken three times per day to get the most benefit.
• Muscle spasms: Some kids will have muscle spasms after surgery. The spasms happen because the muscle becomes irritated after surgery. The spasms can be painful. Sometimes you can see the muscle twitching, or your child may complain of a sudden start of pain. Sometimes changing body position can help. We use diazepam or lorazepam to help with the muscle spasms.

Use these medicines only if recommend by your healthcare provider. Check with your healthcare provider first before giving any type of medicine to your child.

It is important to regularly check your child’s skin while they are wearing braces or casts.

Please call if your child has any of these warning signs:

• Fever of 101.6° F (38.6° C) or higher
• Pain that gets worse even after giving pain medicines according to direction and on time
• Toes that are a lighter shade from normal skin tone
• Skin color change or irritation spreading up the leg
• New bleeding
• Throwing up more than twice and being unable to keep liquids down

During weekday business hours, call the Orthopedics Clinic at 206-987-2109. On evenings and weekends, call the operator at Seattle Children’s at 206-987-2000. Ask the operator to page the orthopedic resident on call