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?

Are there any restrictions after the procedure?