Pre/Post Procedure

Instructions before and following your procedure.

Pre-Surgical

Pre-Surgical Center Procedure Instructions

Pre-surgical center instructions for those undergoing I.V. Sedation for the following procedures:

Transforaminal Epidural Steroid Injections
Facet Joint Injections
Sympathetic Ganglion Blockade
Radiofrequency Rhizotomy/Neurolysis

Do not eat ANY FOOD after midnight the night before your procedure if you receive I.V. Sedation.
You may have CLEAR liquids, such as black coffee, tea, water, soda, or apple juice (no citrus juices or milk) until 3 hours before the scheduled arrival time. Do not have ANYTHING, including water, after that time.
If you have any sedation, you will not be allowed to drive for 24 hours after your procedure. You will need a driver and make arrangements for a responsible adult companion to take you home from the surgery center.
Please bring your insurance card or workers' compensation information with you to the surgical center.
Medications:
- You may take your morning dose of blood pressure medications.
- Discontinue the use of Anticoagulants, Antiplatelet drugs, or Blood Thinners before interventional spinal procedures to minimize the risk of bleeding. You must consult with your cardiologist, primary care physician, or prescribing physician before discontinuing any of these medications and obtain approval and clearance for you to stop these medications temporarily. (See blood thinner instructions)
- If you take insulin, please contact your primary care doctor for instructions. Please bring your insulin along with you.
- If you use an inhaler, please bring it with you.

Epidural Steroid Injections

Back or neck pain accompanied by radiating pain to the legs or arms is often linked to inflammation at the nerve roots located in your spine.

Epidural Steroid Injection is performed to place steroid (anti-inflammatory) medication directly at the source of inflammation and irritation to relieve the pain or radicular symptoms you are currently experiencing.

Strengthening abdominal muscles, weight loss, exercise, or physical therapy may also be necessary to your pain management program.

"What about steroid side effects?" The purpose of this injection is to avoid those side effects. Placing a small amount of steroid medication at the exact spot where it is needed negates the requirement of giving a large oral dose, hoping it gets to your back.

Common side effects include:

Tenderness at the injection site
Increased water retention
Leg cramps
Increased appetite
Increase in blood glucose levels.

If you have diabetes, you should monitor glucose levels closely.

This surgery is an outpatient procedure, typically performed in the office. When a patient requires IV sedation, we perform procedures at an outpatient surgical center.

The duration of the procedure is approximately 10 minutes. Before the injection, the skin is cleansed with an antiseptic solution and numbed with local anesthetic injection. For correct placement into the epidural space, utilization of fluoroscopic guidance assists with the injection of the steroid solution. A small bandage will cover the injection site upon the conclusion of the procedure. Please remove it within 24 hours.

A maximum of three injections spaced about a week to two weeks apart have typically proven effective in providing long-lasting pain relief.

Fluoroscopy Suite Procedures

These instructions are for procedures done at our Fluoroscopy Suite, not the surgical center.

Medications:
- According to the following guidelines before the procedure, discontinue using Anticoagulants, Blood Thinners (Coumadin, Plavix, Lovenox, etc.). (See blood thinner instructions)
- If you use an inhaler, please bring it with you.
- You may take regular strength Tylenol for any discomfort associated with the injection. Continue to take your prescribed pain medications as necessary.
You may drive yourself to and from the office procedure.
It is not necessary to fast before this procedure.
You should go home and lie down for approximately two hours following the injection. After this time, you may resume your normal activities.

Post-Surgical

Post-Surgical Center Procedure Instructions

Post Procedure Instructions for:

Epidural Steroid Injections
Cervical, Thoracic, Lumbar or Caudal
Transforaminal Epidural Steroid Injections
Facet Joint Injections
Medial Branch Blocks

Following your procedure, please follow these instructions:

Continue to take your medications as prescribed. An ice pack placed on the injection site for 20 minutes on, then 20 minutes off may also be helpful.
Remove band-aid from the injection site when the bleeding stops. (Leave on no longer than 24 hours as the adhesive may cause skin irritation.)
Common side effects from steroid injections include:

Flushing or feeling of warmth
Increased water retention
Leg cramps
Increase in appetite
Increase in blood glucose levels. Note: If you have diabetes, you should monitor your blood sugar levels closely.

*These side effects are to be expected and should not be cause for concern.

If you experience any of the following symptoms within 48 hours after today’s procedure, please call the office at 877-87 DR JIM (877-873-7546)

Redness, swelling, or drainage at the injection site
Fever or chills
Severe headache
An increase in numbness and tingling in arms or legs

Blood Thinners

Blood Thinner Instructions

To minimize the risk of bleeding during interventional spinal procedures, Anticoagulants, Antiplatelet drugs, and Blood Thinners must be discontinued.

You must consult with your cardiologist, primary care physician, or prescribing physician before discontinuing any of these medications and obtain approval and clearance for you to stop these medications temporarily. You may restart the day following (24 hours) the procedure unless otherwise noted.

Coumadin (Warfarin) must be discontinued five days before the procedure. In addition, you MUST obtain a PT/INR level the day before your procedure. INR needs to be 1.2 or less Restart the evening following your procedure.
Ticlid (ticlopidine), Iprivask (desirudin), Refludan (lepirudin), Angiomax (bivalirudin), Novastan (argatroban), Exanta (elagatran/ximelagatran) must be discontinued 14 days prior to the procedure.
Vitamin E products and the following supplements: Fish Oil, Garlic, Ginseng, Vitamin A, Ginger, Kava Kava, Clove, White Willow Bark, or Gingko Biloba must be discontinued seven days before the procedure.
Aggrenox (aspirin/dipyridamole), Persantine (dipyridamole), Arixtra (fondaparinux), and Orgaran (danaparoid) must be discontinued seven days before the procedure.
Plavix (clopidogrel) and Pletal (cilostazol) must be discontinued seven days before the procedure. You must wait three hours after the procedure to begin restarting them.
Aspirin or aspirin-containing products must be discontinued five days before the procedure. Aspirin-containing products include but are not limited to “Baby” aspirin, Anacin, Alka-Seltzer, Bufferin, Excedrin, Ecotrin, etc.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as Ibuprofen, Motrin, Advil, Aleve, Voltaren, Arthrotec, DayPro, Indocin, Relafen must be discontinued five days before the procedure.
You must discontinue using Xarelto (rivaroxaban), Pentoxil, and Pradaxa four days before the procedure.
ReoPro (abciximab) must be discontinued 48 hours before the procedure.
Heparin must be discontinued 24 hours before the procedure. You must wait three hours after the procedure to begin restarting Heparin.
Lovenox (enoxaparin), Fragmin (Dalteparin), and Normiflo (Ardeparin) must be discontinued 24 hours before the procedure.
Aggrastat (tirofiban) and Integrilin (eptifibatide) must be discontinued eight hours before a procedure.