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Common Medications used in Patients before or after Surgery

Surgical patients may receive a surprising number of new medications during their hospital stay. The most common medications used for surgical procedures can be grouped into one of several categories including antibiotics, anticoagulants, pain relievers, and steroids as well as a few miscellaneous surgical drugs.

Antibiotics:

Antibiotics commonly used in surgical patients include antibiotics covering anaerobic bacteria, drugs that treat mixed infections caused by both aerobic and anaerobic bacteria, medications particularly effective against the dangerous bacteria known as Pseudomonas aeruginosa, antibiotics that prevent infections from normal skin flora in surgical patients and antibiotics with strong action against other gram-negative bacteria that are frequent sources of infection.

Anticoagulants:

Anticoagulants are medications that must be discontinued prior to surgery. These medications are then also frequently used in patients following major surgical procedures. Post-surgical patients are at an increased risk of blood clots so anticoagulants are used in an attempt to prevent this potentially fatal surgical complication. The anticoagulants commonly used include heparin and low molecular weight heparin also known as LMWH or Lovenox. Heparin is used preferentially in patients who are at increased risk of dangerous complications from bleeding because the effects of heparin, in contrast to Lovenox, may be quickly reversed by a medication called Protamine. Occasionally, certain post-operative patients require long-term anticoagulation and are placed on Warfarin after several days of Heparin or Lovenox.

Pain relievers:

Pain relievers are almost always required in patients following a surgical procedure. The strength of the pain relieving agent depends on the degree of pain and the tolerance of the patient to the pain medication. Most pain-relievers used in surgical patients are narcotics. These may include hydrocodone, oxycodone, morphine, demerol, dilaudid or fentanyl among others.

Steroids:

Steroids are a fourth group of medications that are used in certain patients that are planning to undergo, or have recently undergone, surgery. Steroid medicines such as prednisone or hydrocortisone are used in patients who were on steroids prior to the surgery, in patients who require immunosuppression (such as organ transplant patients), in patients with autoimmune diseases or who have Addison’s disease and require hormone replacement as well as in patients who have spinal cord trauma in order to limit spinal cord compression from tissue swelling.

Though steroid medicines are required for certain patients prior to and after surgery, they are often only used when absolutely necessary due to the deleterious effects of steroids upon wound healing. Steroids inhibit the healing of surgical wounds. However, research has shown that the administration of Vitamin A can counteract the inhibition of wound healing caused by steroid medications.

Other surgical drugs:

Miscellaneous medications that are frequently used in surgical patients include several drugs that affect the gastrointestinal system. These include H2 blockers such as Pepcid or Zantac and proton pump inhibitors (PPIs) such as Prilosec or Nexium that may protect against gastric ulcers and gastritis. Other medications are used for their anti-emetic properties in patients who are nauseous, such as Phenergen and Zofran. Acetominophen is commonly used in surgical patients with fever.

There are numerous medications that may be used in a surgical patient. Health care providers and patients should ensure that they are well informed as to the indications, risks and contraindications for each of these medications prior to use.

Source: Blackbourne, L. Surgical Recall. 3rd Ed. 2002.