Pre-Operative Instructions for
Major and Minor Procedures


Minor Procedures include a collection of minimally invasive diagnostic tests and treatments.  For example, they include:  trigger point injections; epidurals; selective blocks; discograms; facet blocks; pain pumps; and, IDET proceduresMajor procedures include operations that ordinarily require a hospital stay.  On average they are a little longer and a little riskier than "minor procedures."  These include: carpal tunnel surgery; cervical discectomy; disc decompression; lumbar discectomy; lumbar fusion; and, disc replacement. This section describes what you need to do before either a major or a minor procedure.


Dr. Lieberson will personally do your procedure.  He often works with a surgical assistant such as Dr. Panganiban.  Dr. Lieberson also most commonly uses an anesthesiologist sot that the patient is comfortable during the procedure.


You will need to do several things to help before the procedure. These include:

  1. Stopping medications before surgery;

  2. Occasionally starting other medications;

  3. Attend pre-operative visits with the doctor and the hospital;

  4. Do not eat, drink or smoke before surgery;

  5. Bring your films to the hospital or surgery center;

  6. Arrange for a ride home;

  7. Set up your house for your recovery; and,

  8. Get your medications and your post-op visit time.


Print out this page and use it as a check-list so that you do not forget anything.


q Stopping medications before surgery;


Before most procedures you must stop drugs that interfere with clotting.  These include Aspirin, Anti-inflammatory medications, blood thinners, antiplatelet drugs.  Before the procedure, you will need to adjust any medications that you may use for diabetes or for your heart.


For those undergoing a myelogram the instructions are different.  In addition to the medications above, the following medications must also be discontinued two days (48 hours) before the myelogram

Most anti-depressants including:  Amitriptyline (Elavil), Amoxapine (Asendin), Bupropion (Wellbutrin, Zyban), Clomipramine (Anafranil), Desipramine (Norpramin), Doxepin (Sinequan, Adapin), Fluoxetine (Prozac), Imipramine (Imiprin, Tofranil), Isocarboxazid (Marplan), Maprotiline (Ludiomil), Nortriptyline (Pamelor, Aventyl), Phenelzine (Nardil), Protriptyline (Triptil, Vivactil), Sertraline (Zoloft), Tranylcypromine (Parnate), Trazodone (Desyrel, Tracon), and Trimipramine (Surmontil, Apo-trin).

Most phenothiazines including:  Thorazine, Compazine, Promethazine (Phenergan), Serentil, Flexeril, Mellaril, Stelazine, Sparine, Prolixin, and Tindal.


For high risk patients on blood thinners, or for those with bad diabetes, we often ask you to see your internist to see you for "clearance" and any special instructions.


Special instructions:


q Occasionally starting other medications;


If you have certain medical problems, you may need to take medications before surgery.  These will be prescribed before surgery at your pre-operative visit.  Most commonly, antibiotics will be given.  These are used if you are at a higher risk of infection, if you have ever had allergies to medications, if you have had heart problems, or if you have ever had problems with anesthetics.


Special instructions:


q Attend pre-operative visits with the doctor and the hospital;


Dr. Lieberson, or one of his associates will see you before surgery.  Dr. Lieberson works with experienced internal medicine doctors and physicians' assistants.  All tests needed tests will be ordered.  Tests that can be done in the office will be completed immediately.  Your other medical problems and allergies will be noted and any needed precautions will be ordered. 


Occasionally we will send you out for a consultation before surgery.  This is sometimes needed to insure that you will be safe.


The hospital or surgery center will sometimes have you come in for a visit before surgery.  Most frequently (assuming that you are healthy)  they will do the pre-operative visit over the phone.


Special instructions:


q Do not eat, drink or smoke before surgery;


Do not eat anything, drink anything or smoke before surgery.  Generally you should not take anything by mouth after midnight the night before.  If your surgery is scheduled late in the day, this rule may be relaxed.  You absolutely cannot eat, drink or smoke in the eight hours before your surgery but you might want to add a little extra time in case we are ahead of schedule.


Special instructions:


q Bring your films to the hospital or surgery center;


You should have your x-rays, MRI scans, and other studies.  Bring everything to the hospital.  The films and studies are not automatically delivered.  If you forget to bring them, we may have to send you home to collect the films.  We can help you get copies of everything you need before surgery.  We can tell you what is needed and help you get the copies you need.




Special instructions:


q Arrange for a ride home;


A responsible adult must take you home.  We are not allowed to send you home by taxi.  This rule is enforced for your safety.  If anything worrisome happens, your companion will be available to help you.


Special instructions:

q Set up your house for your recovery; and,


If you need a major surgery, such as a fusion, it is a good idea to have a bed on the first floor of your house.  You will want to be near a bathroom and you will want a telephone nearby.


Special instructions:


q Get your medications and your post-operative visit time.


We will either give you the medications in the office or we will give you a prescription.  This will depend on your insurance.  If you get a prescription, fill it before surgery so that you will not need to stop on the way home from the hospital or surgery center.


We will give you an appointment for a visit after surgery.  This may be changed if your hospital stay is longer or shorter than expected.


Special instructions:


Go to the page on post-operative instructions.


Go to the chapter on minor procedures.


Go to the chapter on major procedures.

The information in this site briefly describes issues related to medical treatments, and has been licensed by from Northern California Neurosurgery Medical Group, Inc., who is solely responsible for said content.  This web site is not a substitute for good medical care or for a consultation with a spine specialist. It should not be used to plan your treatment. The well considered advice of a specialist who has personally examined you is always superior to even the best internet pages.

Copyright 2007, Northern California Neurosurgery Medical Group. All rights are reserved.  No part of this web site may be reproduced, transmitted, or stored, electronically or on paper, without the written permission of the Northern California Neurosurgery Medical Group, Inc.
Last modified: 07/27/08