If you are to have sedation, you must have nothing to eat or drink for 6 hours before the scheduled procedure time. You may take your routine medications except those listed below with a small sip of water during this 6 hour period
For all sedation procedures you must have a driver to take you home. Because of the unpredictable effects of anesthesia, patients may be disoriented or crash their vehicle driving after a procedure. It is suggested the patient not drive for at least 12 hours after a procedure.
If you have a surgical procedure such as spinal cord stimulator temporary or permanent implant, intrathecal infusion trial or pump implant, selective endoscopic discectomy, foraminoplasty, or vertebroplasty, you must have a caregiver stay with you overnight. It is strongly suggested for any spinal procedure or procedures near the lung you also have a person remain with you overnight.
Certain drugs must be discontinued prior to surgery or procedures. Coumadin/warfarin must be discontinued 72-96 hours prior to the procedure, aspirin (except one a day baby aspirin) needs to be discontinued one week in advance. Ticlid and Plavix need to be discontinued one week prior to a procedure. There is no reason to discontinue NSAIDS such as Motrin, Ibuprofen, Mobic, Relafen, Naprosyn prior to a procedure. Also, narcotics, ultram, celebrex, bextra are safe to be continued up to the time of the procedure unless your physician from APM tells you otherwise.
Some locations require an anesthesiologist be present for administration of very heavy sedation or general anesthesia. Some of these locations are Surgery Center of Indianapolis, Franciscan Surgery Center, St. Francis Hospital Operating Suites, Indiana Surgery Center, Columbus Regional Hospital Operating Suites, Columbus Surgery Center, Decatur County Hospital Operating Suites. Other locations such as Columbus Regional Hospital Special Procedures Suites, St. Francis Hospital Pain Center Beech Grove, Pain Center at Columbus Regional Hospital, and the Offices of APM Surgery Suites do not routinely use anesthesiologists. Because there are variations in requirements, you may be requested to attend a pre-operative clinic if you have severe health problems with your heart or lungs prior to the procedure.
For IV sedation or general anesthesia, an IV will be placed in the back of your hand or in the bend of your arm
After Procedures: Injections: Often patients will experience temporary soreness after injections from the placement of the fine needle through the skin and muscle. Generally this passes after a few days. Usually ice placed on the back the first night will help reduce any discomfort from injections. Notify the office if there develops any new unexpected numbness or weakness after the procedure. Red flag signs: Call the physician immediately if there is any new loss of bowel or bladder control, severe pain with fever or chills, drainage from an injection site, severe weakness in the lower extremity, new shortness of breath, or a new onset of severe pain radiating down the leg (not merely worsening of the same pain). For these emergencies call the office during office hours or after hours have your physician paged at 812- 379-4441. If the block is for diagnostic purposes (eg. medial branch block to the facet joints, pain mapping, celiac plexus diagnostic block, etc) then the patient will be asked to keep a written assessment of pain reduction and any increased function during the first 6 hours after the procedure on an hourly basis. Typically this is done by using a percent reduction in pain vs. the pre-injection pain. In such situations, the patient usually is instructed to call the clinic the following day with the hour by hour report of pain reduction during the first six hours after the procedure. If the block is being performed for therapeutic purposes such as epidural steroid injections, transforaminal blocks, sacroiliac injections, intra-articular facet blocks, etc, then you may not begin to have a reduction in pain until 24 hours after the block. Neurodestructive Procedures: After a neurolytic procedure such as radiofrequency facet denervation, botulinum toxin (Botox) injection, celiac plexus alcohol block, cryoneurolysis of peripheral nerves, laser procedures on the facet joints, etc., patients may report a flare up of pain for approximately one week then the pain will gradually dissipate. If these procedures are going to be effective, they do so within a few days to a week after the procedure. Use ice for up to a week afterwards to help with muscle soreness and over the counter ibuprofen (if you can tolerate this medicine) often helps. The same red flag signs above apply. Neuromodulation Procedures: These procedures include spinal cord stimulation, intrathecal infusion pump or trial catheter implantation, tunneled epidural catheter placement, peripheral nerve stimulators implanted, etc. Often from trial catheter or lead placement there will be a small amount of drainage from around the entry site into the skin. For permanent pump or stimulator implants, there will be mild swelling and some slight redness around the operative wound edges only. Occasionally there may develop a swelling over the pump or stim which may be due to serous fluid collection (seroma), infection (abscess), blood collection (hematoma), or collection of spinal fluid (CSF leak or pseudomeningiocele). Contact your doctor for any swelling around these devices. Rare neurological complications may include development of a blood clot around the spine with resultant severe weakness of the legs, saddle anesthesia, and possible loss of bowel or bladder control. Notify your doctor immediately for these conditions. Bleeding from the skin is common for the first 12 hours after surgery and is usually handled by simply lying on the wound for 45 minutes to compress the blood vessels and stop the bleeding. Large collections of blood do need the attention of the physician. Any new neurological symptoms after implantation such as falling, weakness, new numbness, bowel or bladder dysfunction, etc. require the physician's attention. The red flag symptoms above also apply.
Minimally Invasive Spine Surgery: It is critical after such surgery that the patient understand the problems which may occur as normal risks of surgery such as bleeding, infection, nerve injury. The timing of reporting problems is also important in that early intervention when indicated, may help reduce the long term consequences of surgical side effects. Because the surgery is taking place immediately adjacent to the spine, there is a possibility of severe postural headache (severe when standing but nearly goes away when lying down with the head down), infection of the muscles or disc (severe pain in the low back, worse when standing, sometimes worse at night, low grade fever, slightly elevated white count, etc.). Such a condition mandates an MRI and possible discal biopsy. Nerve injury is a definite part of the risks assumed. Injury to such may lead to weakness or numbness. After a MISS procedure, stay in contact with the physician through the office hours when possible 8:00-4:30 M-F or page your physician at night if there exists an emergency which may be directly related to the surgery.
