PRE-PROCEDURE INSTRUCTIONS:

We advise you to arrive at the office at least 30 minutes prior to your scheduled procedure time. Call at least 24 hours prior to your procedure, if you need to cancel. If you are more than 15 minutes late, then you will have to wait until the next opening on the procedure schedule to have your procedure. Make sure someone will be able to stay in the office during the procedure and be able to drive you home. You may be in the office for approximately 1 hour. If you are SICK or have an INFECTION, and are taking antibiotics, PLEASE call and ask to speak to a nurse as your appointment may need to be rescheduled.

Transportation: Prior to your procedure, you will need someone to provide transportation home. You MUST have a designated driver to take you home. Your ride must be present with you at the time of your procedure and must stay in the facility until you are discharged from the recovery area. You will still need a designated driver if you do not receive sedation. You do not need sedation for the procedures but it is available. Please notify the staff of your preference.

Food & Drink: Light meal in the morning of the procedure is allowed. You will get additional instructions separately if you are getting any sedations.

Medications: You may take any prescription medications, including your pain medications on the day of the procedure with a sip of water. Medications such as blood pressure and asthma medications should be taken with a small sip of water on the day of your procedure. If you have valvular heart disease or receive antibiotics prior to dental procedures, please inform us to obtain a prescription for an antibiotic. If you are taking BLOOD THINNING MEDICATIONS, it is recommended that you hold these prior to your procedure. You MUST check with your prescribing physician or anticoagulation clinic for specific recommendations prior to stopping these medications. A written authorization from your physician is needed. The following are general guidelines:

• Plavix (Clopidogrel) and Effient (Prasugrel) should be held for 7 days

• Coumadin (Warfarin) should be held for 5 days. You will need an INR drawn the day of, or the day before your procedure, and the results faxed to 864 286 3077.

• Brilinta (Ticagrelor) and Ticlid (Ticlopidine) should be held for 5 days.

• Arixtra (Fondaparinux Sodium) and Pradaxa (Dabigatran Etexilate) should be held for 4 days.

• Eliquis (Apixaban) and Xarelto (Rivaroxaban) should be held for 3 days.

You may be given a prescription for an anxiolytic medication such as Ativan or Xanax that should be taken 1 hour prior to the procedure to minimize anxiousness. We can also prescribe you a quick acting pain medication such as fentanyl lozenges (actiq lollipop) which could be taken during the procedure. Please inform us if you need a prescription for these medications. Single Fentanly lollipop may not be available in all pharmacies. Most insurance plans do not cover the cost of this lollipop.This medication is advisable only if you have multiple needle procedures.

Diabetic patients: Please check your glucose level at home before you come in for your procedure and bring your glucose meter to our clinic.

Pregnancy: If you think you may be pregnant, trying to become pregnant, or is of child-bearing age, you MUST let the staff know.

Clothing: Please wear loose, comfortable clothing the day of your procedure. To maintain cleanliness of the injection site, please bath or shower the night before or the morning of your procedure

• Chemical Sensitivity: Scents may trigger responses in those with chemical sensitivities. Please avoid wearing scented personal products when visiting the Pain Management Center.

We may occasionally start an intravenous line to administer medication during spinal procedures.

POST PROCEDURE INSTRUCTIONS:

(A full list will be given to you after the spinal injection)

Take the rest of the day light, no long distance driving, no lifting and loading, no sports. The next day, you may resume your usual activities within the level of tolerance. You may have muscle soreness for about 24-48 hours after the procedure. You may take any over the counter pain medication by mouth and place ice packs over the affected area. Benefits of the procedure will be realized after 36-48 hours. The best effect may take up to 2-3 weeks to occur. Resume all medications, try to avoid the pain medications after 1-2 days. You may be scheduled for a follow up visit in 3-4 weeks to discuss future plan.