Instructions

Instructions for patients prescribed blood thinner medications

Blood thinner medications to be on hold prior to all epidural steroid injections:

Aggrastat (tirofiban), eptifibatide must be hold for 4-8 hours prior to the epidural steroids injection. 

Reopro (abciximab) must be hold for 24-48 hours prior to the epidural steroids injection.  

Aspirin, NSAIDs, Pradaxa (dabigatran etexilate), Xarelto (rivaroxaban), Eliquis (apixaban) must be hold for 3 days prior to the epidural steroids injection. 

Coumadin (warfarin), Brilinta (ticagrelor) must be hold for 5 days prior to the epidural steroid procedure.  Also INR levels should be checked and to be equal or lower than 1.5.

Plavix (clopidogrel), Effient (prasugrel) must be hold for 7 days prior to the epidural steroids injection. 

Aggrenox (aspirin/dipyridamole), Tclid (ticlopidine) must be hold for 14 days prior to the procedure. 

The holding of medication must be approved and confirmed with the primary care physician or cardiologist.

Aspirin, NSAIDs and all blood thinner medications could be continued for all non-epidural steroid injections and diagnostic blocks if the patient assumes the risks of bleeding and complications and signs that appropriate form.

INR levels must be checked for each patient currently on Coumadin therapy regardless of the nature of the interventional procedure.

Antibiotics

No procedures could be scheduled when the patient is taking antibiotics for any kind of infection.

The antibiotic treatment regimen must be completed at least 48 hours prior to the procedure.

The only exception is when the patient is on prophylactic antibiotic. Each of these cases must be confirmed with physician performing the injection.

Steroid medications oral and injections

All interventional procedures requiring using steroid medications can be scheduled only 14 days after the last steroid injection performed. The exception is radiofrequency ablation which has to be scheduled 7 days apart and minimal steroid medication amount is used.  Scheduling of the interventional procedures involving using steroid medications for less than 14 days after the recent steroid injection of any kind must be confirmed with the physician performing the procedure.

                                     Discharge Post Spinal Injection/ Procedure Instructions

Instructions:

Notify the office of the doctor who performed your procedure if you experience any of the following:

• Fever of 100*F or 38*C or greater.

• Excessive swelling or redness at the injection site.

• Excessive pain or numbness that lasts longer than 72 hours after your injections.

• Severe headache that goes away when you lie flat and comes back when you sit upright

Activity:

• Rest after your injection for 24 hours,then return to your usual activities. This includes any restrictions your physician may have prescribed.

• Do not drive the day of your injection unless discussed with your physician.

Care of the injection site:

• You may ice the injection site for local discomfort. Cover ice with a cloth and apply light pressure. Never place ice directly on the skin.

• Apply ice for 15 minutes on then off for 1 hour. Repeat as needed.

            Take band aids off the following day.

For diabetic patients:

• Check your blood sugar level every 8 hours for the next 72 hours. If it is greater than 250, call your primary care physician.

Medications:

• You may resume your pre-injection medications as previously prescribed.

• Remember, the steroid you had injected today usually takes 1 to 3 days to take a first effect, however it takes up to 7-10 days to have the full benefit from the medication.

Contacts/Questions:

In case of an urgent issue or questions:

• Dr. Tsymbalov's medical assistant, Hannah can be reached at (678) 909-0911

• Call will be redirected to the voicemail service at after 3:00 PM, on the weekend or a holiday. 

Follow-up Office Visit: Your post op appt. will be scheduled after the procedure

• Please contact the clinic if you need to make any changes.