Pain management injection procedures

Background Information

Patients should provide the Interventional Pain Program with any medical information (allergies to antibiotics, drugs, contrast, latex, sea food, etc.). Also, provide medical history of:

• Bleeding disorders and anticoagulation (coumadin/heparin) medication

• Aspirin

• ticlid

• NSAIDs

• Diabetes

• Seizure disorders

• Need for prophylactic antibiotics (prosthetic implants/artificial valves)

• Pregnancy and breast feeding

• HIV

• Hepatitis C

Preparing For Your Procedure

1. Do not eat solids for six hours or drink liquids for two hours prior to your procedure. You may take a sip of water if you need to take medicine.

2. Take your usual medicines on the day of the procedure unless instructed otherwise by your doctor.

3. You cannot take aspirin (including baby aspirin) one week prior to the procedure. If you take aspirin for your heart or blood vessels as prescribed by your doctor, you will need a written note from your doctor saying it is OK to stop taking your aspirin.

4. You cannot take Plavix (clopidogrel) for one week prior to the procedure. You will need a written note from your doctor saying it is ok to stop taking your Plavix.

5. You cannot take anti-inflammatory medicines 24 hours prior to the procedure. Examples of anti-inflammatory medicines are: Advil, ibproufen, edtodolac, indomethacin, naproxen, Aleve, Feldene, diclofenac, Mobic, and piroxicam. You do not need to quit taking Celebrex prior to the procedure. If you are unsure if any of your medicines are anti-inflammatory medicines, ask your doctor.

6. You cannot take herbal medicines, fish oil or Vitamin E for three days prior to the procedure.

7. Call your family doctor for instructions if you take blood thinners such as heparin or coumadin(Warfarin). Your blood clotting times will need to be normalized (INR less than 1.5) prior to your procedure if you take blood thinners.

8. Call your family doctor for instructions if you take medicine for diabetes. This procedure may temporarily increase your blood sugar if you have diabetes.

9. If you have glaucoma, this procedure could worsen your glaucoma. Please discuss this with your eye doctor to see if this procedure is safe for you.

10. Before the procedure, tell us if you have any drug allergies or if you have had a reaction to X-ray dyes (contrast dyes), iodine, betadine, seafood, shellfish, latex or local anesthetics (numbing medicine).

11. Make sure someone is able to drive you home. You cannot drive yourself home after the procedure.

12. Bring your pain medicines with you to the hospital when you come for your procedure. Make sure you have enough pain medicine for after the procedure. You may still need to take it after the procedure. The doctor who performs your injection will not give you a prescription for pain medicine to take home.

13. Bring the latest version of any MRI or CT scans if these were not performed at a UW Health facility. You are responsible for getting and bringing your films. If you do not bring these films with you on the day of your procedure, your procedure cannot be performed. If you have had any spine surgery in the past, you need to bring an MRI or CT scan that was obtained after your surgery. If are unsure where or when your MRI or CT scan was done, call your doctor. If your scan was done at a UW Health facility, you do not need to bring your films.

14. You must be healthy on the day of the procedure. You must be free of infection, not taking antibiotics for two weeks prior to the procedure, and without cold or flu symptoms for two weeks prior to the procedure. You also must not have any rashes for two weeks prior to the procedure. If you are feeling sick or have a cold prior to the procedure, call the procedure team to let us know. Please try to call at least 24 hours prior to the procedure.

15. Call (608) 265-1770 or (608) 265-1729 if you need to cancel your procedure or have any questions regarding your procedure.

The Day of the Procedure

1. You will be escorted to a pre-procedure prep area. Before the injection, you will change into a hospital gown and an IV will be started in your arm.

2. You will be asked many questions about your medical history, current health and current medications. You will also fill out a pain diagram.

3. A health care provider will go over a procedure consent form with you. The purpose of the procedure, brief description of the procedure, and potential complications will be explained to you. If you have any questions, they will be answered at this time. Your family and friends can be with you before and after the procedure. No family members or friends are allowed into the procedure room.

4. The test/procedure is performed in an operating room equipped with an X-ray machine. A sedative medication will be given through the IV to make the procedure as easy as possible. However, you will remain awake throughout the test/procedure.

5. You will lie on the procedure table, on your stomach for low-back injections and on your side for neck injections. We will monitor your blood pressure, heart rate and oxygen saturation throughout the procedure. We will use pillows to help position you and make you comfortable.

6. The area to be injected will be thoroughly cleaned. Then, your neck or back will be covered with a sterile drape.

7. Using the X-ray machine, your doctor will carefully guide a thin needle into your back or neck near the spine. The exact position depends on the type of injection. Your doctor will inject some X-ray (contrast) dye through the needle to verify the correct position of the needle. X-rays will be taken.

8. The local anesthetic (numbing medicine) and steroids (anti-inflammatory medicine) will be injected. During the procedure, you will be asked to lie very still and minimize talking. The procedure usually takes 30 to 45 minutes.

About Sedation

The procedure is performed under intravenous sedation unless you specifically request no sedation. Short-acting benzodiazepines (Versed) and opioids (Fentanyl) are given intravenously just before the procedure and as needed during the procedure for sedation and pain relief. The medicines are are designed to keep you comfortable and drowsy. At all times you will be conscious and responsive, yet relaxed and comfortable.

After the Procedure

1. When the procedure is complete, you will go to the recovery room where nurses and your doctor will monitor you for 15-30 minutes.

2. You will be asked how much pain you are having and the location of the pain. The recovery room staff will make sure you have something to eat and drink.

3. Before you go home, you will be examined briefly to make sure you are doing OK.

4. You will be given a pain log to complete for the next 14 days. This will let us know if and how much your pain was decreased. If you do not fill out and send back your pain log, we cannot do more procedures on you.

5. A Health Facts for You sheet will be given to you before you leave. It will explain what to expect following your injection and what to do if you have questions or concerns about the injection.

6. Your driver will take you home. You may not drive for 24 hours after receiving sedative medications.