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PRE-PROCEDURE INSTRUCTIONS 1. Please arrive 15 minutes before your procedure time.

2. If you are having a procedure in the head, neck or upper back, please DO NOT eat for 6 hours before the injection. You may have clear liquids up to 3 hours before the procedure (Clear liquids include: water, apple/ cranberry juice, ginger ale, black coffee, or black tea but no milk, sugar, citrus juices, gum, or mints). If you are having a low back, trigger point, or joint injection, you may have a light meal prior to the procedure.

3. Do not wear any skin lotion prior to any proπcedure.

4. You may be asked to change into a gown. Please dress in comfortable, loose clothing and flat rubber soled shoes (please no heels or flip-flops).

5. You may take your medications as usual on the day of the procedure, except for: ______see attached form for guidance on stopping blood thinning medications___________

6. Please notify us if you become ill or develop an active infection. If you develop a bacterial infection, you must have completed antibiotic treatment and be free of infection for 2 days before a procedure can be done.

7. You should arrange for a ride home after the procedure. You may not drive or operate machinery for 24 hours after a spinal procedure.

8. Expect to stay at least 15-30 minutes after the procedure, so that we may monitor you. If you are undergoing a Radiofrequency Lesioning procedure, please expect to stay ONE HOUR after the procedure for recovery. You will be requested to remain in a wheelchair until we determine that it is safe for you to walk.

9. After discharge, you will be asked to rest at home and place ice on the injection site. Please plan accordingly.

10. DO NOT stop any blood thinner unless your cardiologist or primary care physician (PCP) approves it.

11. If you are a diabetic and are having a steroid injection, you will need to follow your blood sugars closely for up to 3 weeks after the procedure. Contact your PCP if your blood sugars are elevated after the procedure.

12. If you will be taking a sedative for premedication, please arrive 30 minutes prior to your procedure. 

Alprazolam as directed (Take 1 tablet 1 hour prior to procedure, then take 1 tablet as needed 30 min prior to procedure). Do not drive, operate machinery or make any legal decisions for 24 hours after taking the sedative. If you have any questions, please call our office at 0705250101.

Your procedure is scheduled for _________________________ am/pm on _________________

PLEASE SIGN BELOW THAT YOU UNDERSTAND YOUR PREPROCEDURE INSTRUCTIONS.

PATIENT’S NAME (PRINT): ....................................................................................................................

SIGNATURE: ..................................................................................... DATE: .........................................

POST--PROCEDURE INSTRUCTIONS 1. Today, you have received an injection for the management of your pain. Please expect some discomfort for the next 2--3 days following your procedure. Use of ice to the injeciton site for increments of 20 minutes at a time every hour may be helpful in reducing any discomfort.

2. Go home and rest today. Limit your activities today.

3. If significant redness, swelling , warmth or severe pain occurs at the injection site , please call our facility.

4. If you develop a fever and/or chills or bowel or bladder problems, please call our facility.

5. It is not uncommon to develop numbness or weakness in an extremity after a spine or lower extremity nerve injection. Please use great care with weight-bearing activities, as you may be prone to falling. Have someone assist you with walking, if necessary. It is advised that you remain off your feet until the numbness and/or weakness subsides, usually within 2--4 hours. If the numbness or weakness persists beyond the day of the procedure, please call our facility.

6. Do not drive or operate machinery for the next 24 hours, unless instructed otherwise.

7. If you have been taken oral sedating medication, it is advised that you do not operate machinery, drive or make legal decisions for the next 24 hours.

8. If you experience a headache, continue resting, lie flat on your back, elevate your legs and drink extra caffeinated fluids. If your headache lasts greater than 24 hours, please call our facility.

9. Keep the injection site and Bandage clean and dry on the day of the procedure. In the morning, following the procedure, remove the Bandage and cleanse the area thoroughly with soap and water. You may then resume normal activities.

10. If you stopped a blood thinning medication for your procedure, restart it 24 hours after your procedure.

11. If you are a diabetic and received a steroid injection today, please follow your blood sugars closely over the next 3 weeks. If your blood sugars, are high, contact your PCP immediately to help you control your blood sugars.

Your follow--up appointment is scheduled for ………………………… am/pm on .....................................................

PLEASE SIGN BELOW THAT YOU UNDERSTAND THE ABOVE INSTRUCTIONS

PATIENT’S NAME (PRINT): . .................................................................................................................................

SIGNATURE: .................................................................................. DATE: ......................................................