INJECTIONS & PROCEDURES

INJECTIONS

A broad variety of injection procedures are available and may be applicable to your condition. Most are performed using some form of assisted guidance to ensure precise placement.

Patient Procedure Instructions
Important: These instructions must be followed for your safety and to prevent your appointment from being rescheduled. Your help is appreciated!

MEDICATIONS:
Review medications on our med restrictions list. See the list item “Med Restrictions for Injections” below to view. Please call your pharmacist or our office if you have questions.

DO NOT STOP your heart, blood pressure or lung medications. You may take them with a small sip of water no later than 2 hours before your scheduled arrival time. Bring asthma inhalers with you.

If you use Coumadin, Plavix or other platelet inhibitors, your prescribing physician will be contacted regarding the discontinuing of these medications prior to SCHEDULING your procedure.

Do not stop these medications until our office has received clearance from your prescribing physician.

PATIENTS THAT WEIGH > 300 LBS:
Notify our scheduling staff if you weigh in excess of 300 pounds. You will be asked your height and weight at the time of scheduling. If your weight exceeds safety protocol for our equipment, based on body mass index (BMI), your injection may be scheduled at a different facility.

DIABETIC PATIENTS:
If you are diabetic, please schedule your appointment prior to 10:00 am. You will take your diabetic medication as scheduled.

IF YOUR PROCEDURE REQUIRES SEDATION AND IS SCHEDULED PRIOR TO 10 A.M.

Take normal oral diabetic medication and if you are on insulin, take ½ your normal dose.

IF YOUR PROCEDURE REQUIRES SEDATION AND IS SCHEDULED FOR AFTER 10 A.M.

Take all oral and insulin medication doses as scheduled.

DEVELOPMENT OF ANY NEW SYMPTOMS:
Notify us immediately if you develop signs or symptoms of a cold, productive cough, flu-like symptoms, fever or other sickness. If you are being treated by another provider with an antibiotic for ANY reason, PLEASE CALL AND RESCHEDULE YOUR PROCEDURE. YOU MUST HAVE COMPLETED THE ENTIRE COURSE OF THE ANTIBIOTIC PRIOR TO ANY SCHEDULED PROCEDURE.

FEMALE PATIENTS:
If you are female of child bearing age, with no history of a hysterectomy or tubal ligation, we will obtain urine pregnancy test prior to your procedure.

SEDATION PATIENTS:
Only our RF procedures require sedation.

If you are having IV sedation, you must fast as directed, usually 8 hours prior to the procedure. Sips of water may be taken with medications in the morning no later than 2 hours before your scheduled ARRIVAL time.

TRANSPORTATION:
For safety reasons, we request that you have someone drive you home after ANY procedure.

PATIENTS THAT REQUIRE OXYGEN:
If you use oxygen at home FULL-TIME, bring the oxygen with you.

IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE OFFICE AT (720) 274-0341.

You have been referred by your provider to Englewood Surgery Center for an injection. Below is a brief description of what you can expect on the day of your procedure:

You must arrive 30 minutes prior to your scheduled appointment, unless otherwise instructed. You will be asked to undress into a gown. The nurse will then take a brief medical history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING A LIST OF ANY CURRENT MEDICATIONS YOU ARE ON to expedite your check-in process. If you have a family member or friend with you, they are welcome to stay with you during this time. Unfortunately we do not allow small children in the pre-operative area.

The physician performing the injection will meet with you prior to the procedure to discuss any questions you may have. After the injection, you will remain in the post-operative area for approximately 15-30 minutes. The nurses will review post-operative instructions and pain scales that you will be asked to fill out at home.

THERAPEUTIC INJECTIONS FACET, SI (SACROILIAC JOINT), EPIDURAL STEROID, HIP INJECTIONS
These injections are considered “therapeutic” and are meant to help relieve your symptoms.

You may experience some immediate TEMPORARY relief of pain from the numbing medication that will be used. The Steroid medication may not take effect for 3-5 DAYS.

We will have you track your pain at home and ask that you return your pain scales during your follow-up appointment 10-14 days after your injection with your ordering provider.

DIAGNOSTIC INJECTIONS MEDIAL BRANCH BLOCK, SELECTIVE NERVE ROOT BLOCK, SYMPATHETIC BLOCK
These injections are performed to help determine the location and source of your pain. Steroid medications may not be used. The numbing medication used should give you immediate TEMPORARY relief. It is imperative that you use the pain scale you are given to track your pain for 6 hours after the procedure.

RADIOFREQUENCY ABLATION (RF)
This procedure will be scheduled only after 2 successful Medial Branch Blocks unless otherwise determined.

You will need to fast (nothing by mouth from 10pm the night before). If you take any regular medication, we ask that you take it as scheduled with just a small sip of water.

You must arrive 30 minutes before your scheduled appointment. You will be asked to undress into a gown. The nurse will then take a brief medical history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING A LIST OF ANY CURRENT MEDICATIONS YOU ARE ON to expedite your check-in process. The nurse will start an IV on you. You will be receiving “conscious sedation” which means that you will feel relaxed but will not be asleep for your procedure.

If you have a family member or friend with you, they are welcome to stay with you during this time. Unfortunately we do not allow small children in the pre-operative area.

The physician performing the injection will meet with you prior to the procedure to discuss any questions you may have. After the procedure, you will be observed in the post-operative area for approximately 30 minutes. Because you have had sedation, YOU MUST HAVE A DRIVER HOME. Please make sure these arrangements are made in advance.
Purpose
The purpose of an epidural steroid injection is to decrease pain, find out where the pain is coming from or both. Medication is placed directly into the epidural space, which is outside the dura, a fluid filled sack that protects the brain, spinal cord, and nerves. This injection is considered “therapeutic”.

You may experience immediate TEMPORARY relief from the numbing medication that is used. The steroid medication may take up to 3-5 days to work.

What to expect
  • Please arrive 30 minutes prior to your scheduled injection time, unless you have been instructed otherwise. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne or lotion.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 10-15 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 15-30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 10-14 days after the injection and bring your post injection pain scale to that appointment.
Risks
Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.
Purpose
The purpose of a facet joint injection is to decrease pain, find out where the pain is coming from or both. The facet joints are small joints located in the back of the spine and allow the spine to move in multiple directions. The medication is placed directly in the joint space. You may experience immediate TEMPORARY relief from the numbing medication that is used.

The steroid medication may take up to 3-5 days to work.

What to expect
  • Please arrive 30 minutes prior to your scheduled injection time, unless you have been instructed otherwise. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne or lotion.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 10-15 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 15-30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 10-14 days after the injection and bring your post injection pain scale to that appointment.
Risks
Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.
Purpose The purpose of a sacroiliac joint (SI) injection is to decrease pain, find out where the pain is coming from or both. The SI joints are located between the sacrum and iliac bones in the buttock region. The medication is placed directly in the joint space. This injection is considered “therapeutic”. You may experience immediate TEMPORARY relief from the numbing medication that is used. The steroid medication may take up to 3-5 days to work. What to expect
  • Please arrive 30 minutes prior to your scheduled injection time, unless you have been instructed otherwise. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne or lotion.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 10-15 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 15-30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 10-14 days after the injection and bring your post injection pain scale to that appointment.
Risks Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.
Aspirin Products
Stop 7 Days Prior to Any Injection
Anacin, Ascriptin, Aspirin, Arthritis Pain Formula, Aspergum, Aspirin w/ codeine, Bayer, Bufferin, Coricidin D, Dimetap Sinus, Dolobid (Diflunisal), Dristan, Ecotrin, Excedrin, Excedrin Migraine, Pamprin, Florinal, Midol, Norgesic Forte

NSAIDS
Stop 3 Days Prior to Any Injection
Advil, Motrin, Ibuprofen, Aleve, Anaprox, Naprosyn,Ansiad (Flurbiprofen), Cataflam (Diclofenac), Clinoril (Sulindac), Daypro (Oxaprozin), Feldene (Piroxicam), Lodine (Etodolac), Mobic (Meloxicam), Naproxen, Orudis, Relafen ((nabumetone), Sulindac (Clinoril), Toradal (Ketorolac), Visoprofen, Voltaren, Voltaren Gel

Genitourinary
Stop 5 Days Prior to Any Injection
Elmiron (Pentosan Polysulfate Sodium) STOP for 5 days

Platelet Inhibitors
Doctor’s Note Required to Stop these Meds
  • Aggrenox STOP 14 days
  • Effient(prasugrel) STOP 7 days
  • Persantine(Dipyridamole) STOP 3 days
  • Plavix(Clopidogrel) STOP 7 days
  • Ticlid(Ticlopidine) STOP 14 days
Blood Thinners
Doctor’s Note Required to Stop these Meds
  • Arixtra (Fondaparinux) STOP 48 hours
  • Coumadin/Warfarin STOP 4 DAYS
  • Heparin/Lovenox STOP 24 hours
  • Pradaxa(dabigatran) STOP 72 hours
  • Xarelto(Rivaroxaban) STOP 24 hours
  • Fragmin(Dalteparin) STOP 24 hours
Purpose
The purpose of a ganglion block is to anesthetize the sympathetic nerve fibers in the neck. Patients who are candidates for this procedure suffer from sympathetically mediated pain, generally known as complex regional pain or reflex sympathetic dystrophy in the upper extremities and sometimes the head and neck.

These injections usually contain local anesthetic medications. If effective, they can be repeated several times to ensure maximum pain relief.

What to expect
  • Please arrive 30 minutes prior to your scheduled injection time, unless you have been instructed otherwise. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne or lotion.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 10-15 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 15-30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 10-14 days after the injection and bring your post injection pain scale to that appointment.
Risks
Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.
Purpose
A medial branch block is done for “diagnostic” reasons to help your physician determine where your pain generators are located and what additional treatment may be helpful in decreasing spine pain. The medial branches are small nerves that pick up pain from irritated facet or zygapophysial joints, which are small joints located at the back of the spine. If these blocks are helpful, they may be followed by a radiofrequency neurotomy, which can provide longer relief of the pain.

What to expect
  • Please arrive 30 minutes prior to your scheduled injection time, unless you have been instructed otherwise. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne or lotion.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 10-15 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 15-30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 10-14 days after the injection and bring your post injection pain scale to that appointment.
Risks
Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.
Purpose
The purpose of a discogram is to determine if one or more of the discs in the spine are the source of pain. A special dye is injected into the discs to examine the structure of the disc and to determine if this increase in pressure reproduces the patient’s exact pain pattern. The results are then used to determine if more advanced treatment is appropriate. The discogram is not a treatment for pain and should not be performed unless the patient is seriously considering surgery or similar treatment.

What to expect
  • You must be NPO (without solid food or drink) from 10pm the night before your procedure.
  • Please arrive 1 hour prior to your scheduled injection time. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne, or lotion.
  • An IV will be started so we can administer light sedation during the procedure.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 45-60 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 10-14 days after the injection and bring your post injection pain scale to that appointment.
Risks
Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.
Purpose
The purpose of this procedure is to use radio waves to produce heat directed at specific facet joint nerves in order to destroy the nerve and relieve pain. The procedure can be scheduled only after the patient has had 2 successful medial branch blocks to ensure the correct nerve has been targeted.

What to expect
  • You must be NPO (without solid food or drink) from 10pm the night before your procedure.
  • Please arrive 30 minutes prior to your scheduled injection time. You will be asked to undress into a gown. The nurse will take a brief health history and have you sign paperwork necessary to proceed with the procedure. PLEASE BRING AN UP TO DATE MEDICATION LIST in order to expedite your check-in process.
  • In consideration of other patients, please refrain from wearing perfume, cologne, or lotion.
  • An IV will be started so we can administer light sedation during the procedure.
  • If you have a family member or friend with you, they are welcome to stay with you. Unfortunately, we do not allow small children in the pre or post op area.
  • The doctor performing the injection will be in to discuss the procedure prior to your injection.
  • You will be transported into the procedure room and positioned on the table. Your skin will be cleaned with sterile soap and draped in a sterile fashion. The skin over the target injection site will be anesthetized with a local anesthetic. Fluoroscopy is then used to guide the needle into the proper position. Medication is then slowly injected through the needle that has been placed.
  • The procedure itself takes approximately 45-60 minutes and once completed, you will be transported back to the pre-op/recovery area.
  • The nurse will take your vital signs and offer you a snack and drink. Your recovery time stay will be approximately 30 minutes.
  • Post injection instructions will be reviewed and you will go home with a copy. We ask that you schedule your follow up appointment with your ordering provider in 4-6 weeks after the procedure.


  • Risks
    Every medical procedure, no matter how minor, contains some risks. Anytime a needle is placed into the body, there is a risk of tissue injury, infection and bleeding. If this occurs near the spine, it can result in nerve damage. Although extremely rare, nerve damage and death have occurred following spine injections. Injections near the spine also risk puncturing the dura and can result in headaches, which can easily be treated. More common risks include a temporary increase in pain, local tenderness after the injection, allergic reactions to the medications and side effects from the steroids.