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APM Spine & Sports Physicians

Pre & Post Procedure Instructions

Pre-Procedure Instructions

What medication changes must be made before procedures?

  1. Certain diabetic medications:For any procedures using contrast dye, diabetics taking any of the following: Metformin, Sitagliptin, Riomet®, Fortamet®, Janumet®, Glumetza™ and Glucophage®, please follow the following instructions:
    • Do not take these medicines the day of the procedure and remain off for 48 hours after the procedure.
  2. Blood Thinners:
    • For most spinal procedures certain medicines which thin the blood will need to be temporarily stopped.
    • Do not stop any blood thinning medicine without instruction from your physician.In many circumstances, you may need special permission from your primary care doctor or other specialist to determine if it is safe for the medication to be temporarily stopped.
      • For 10 days before the procedure, stop taking aspirin, Plavix® , or Ticlid®,. You may be permitted to take an 81 mg aspirin (baby aspirin) if you are undergoing a lumbar or sacroiliac procedure. Check with your Advanced Pain Management physician to be sure. You must stop all blood thinners including baby aspirin for cervical epidural steroid injections or spinal cord stimulator trials.
      • If you are on Coumadin® (Warfarin), you must have prior authorization from your primary care physician or other specialist before stopping this medicine. If it is felt safe to temporarily stop this medicine, you will be asked to stop the Coumadin 3-5 days before the procedure, and may need blood work the day before or the day of the procedure to ensure Coumadin levels have dropped appropriately. If it is not felt safe to stop this drug, your primary care physician or other specialist may elect to “bridge” you with an alternative injectable blood thinner which can be safely stopped the day before the procedure.
      • For 5 days before the procedure, do not take anti-inflammatory medicines such as ibuprofen (motrin®), naproxen (Alleve®, Naprosyn®), Lodine®, Arthrotec®, Sulindac®, Voltaren®, Feldene®, Diclofenac, Indocin®, Relafen®. Celebrex may be permitted for certain procedures-check with your physician.

Are there any restrictions the night before or day of the procedure?

You may eat light meals on the day of the procedure, unless your procedure involves moderate sedation.

What is considered moderate sedation?

Certain procedures involve the use of moderate (conscious) sedation including discograms, Racz catheter, dorsal column stimulator (spinal cord stimulator), Automated Percutaneous Disc Decompression (DeKompressor™) as well as any procedure it is felt necessary by your physician to use moderate sedation. If you are having one of these procedures, or have been told you will be administered conscious sedation, do not eat or drink for 6 hours prior to the procedure except for clear liquids (water, Gatorade, apple juice etc.). During the 6 hours up until the procedure time remain well hydrated with these liquids. For example if a discogram is at 3 PM, stop eating at 9 AM but please drink water, or other clear liquid up until the procedure time.

Should I drink fluids before the procedure?

Yes. It is important to be well hydrated prior to your procedure.

What can I expect after the procedure?

  • You will need to stay at least 30 minutes after an injection so we can be sure you have not had an adverse reaction.
  • You will need to arrange for someone to drive you home after your procedure unless advised differently by your physician.

Are there any restrictions after the procedure?

  • You should not drive or operate machinery for 8 hours after the procedure (12 hours if moderate sedation was used).
  • Do not engage in any rigorous activity for the next 12 hours.
  • You do not need to lie flat unless instructed by your physician.
  • For spinal cord stimulators (dorsal column stimulator) please check with your physician regarding bathing restrictions.



Post-Procedure Instructions

How soon can I drive?

You should not drive or operate machinery for 6-8 hours after the procedure. If moderate (conscious) sedation was used, you should wait 12 hours.

When can I start taking my medicines again?

All blood thinning medications may be restarted the following day. However if a spinal cord stimulator was placed you must remain off medications until the day after the lead has been removed.

For procedures using contrast dye, certain diabetic medications need to be held the day of the procedure and for 48 hours afterward. These include: Metformin, Sitagliptin, Riomet®, Fortamet®, Janumet®, Glumetza™ and Glucophage®

How soon can I bathe or shower?

Wait 24 hours before sitting in water that covers the injection site. Do not shower until normal sensation and strength have fully returned. However, if a spinal cord stimulator lead was placed, do not bathe or shower until the day after the lead is removed. Sponge bath is permitted.

Will I have to be careful walking?

Until your normal balance and muscle strength returns, use extreme caution and you may not be safe to walk without assistance for 6-8 hours.

How soon can I remove any adhesive bandages?

The same day as your procedure.

How long will it take to feel an effect from the injection?

If you received a local anesthetic, its effects may be immediate. This may wear off in two to six hours, at which time pain may return. If you received steroids with the injection, relief may take up several days.

What can I do if the injection site is sore?

The soreness may last for a few days. Apply ice in 20 minute on/20 minute off cycles.

Could anything require immediate attention?

If you experience any concerning symptoms after the injection such as bowel or bladder problems, weakness, prolonged numbness, headache, fever, redness at the injection region, or exacerbation of pain call your physician.

What if I am prescribed an antibiotic between the procedure date and my next visit?

Please notify us prior to having another procedure. The type and duration of the infection as well as the medication will be relevant to your having another injection. Your physician will determine whether the procedure should be rescheduled based on this information.