Safe Medication Use Before Spine Surgery

Some drugs and spine surgery don’t mix. Here’s what you need to know before your procedure.

If you have a spine surgery scheduled, you likely have a long list of to-dos: Alerting loved ones who might help out, potentially updating your diet, and ensuring your house is recovery-ready. But don’t forget one of the most important parts of spine surgery/or procedure prep—discussing your current medication regimen with your doctor.

womans speaks with female doctorSome medications may be taken right up until your procedure, but you might need to reduce the dose or stop taking certain drugs days or even weeks before your spine surgery. This is because medications may affect your recovery and response to anesthesia.

While some general medication guidelines are included below, you should always follow your care team’s specific medication advice as it relates to your procedure. Every patient is unique, and medication needs before, during, and after spine surgery may vary from the general recommendations noted in this article.

Before Surgery: Prepare a Medication Audit
Your surgeon and their medical team will carefully review your medical history, coexisting medical conditions, previous surgical experiences, and the results of preoperative laboratory or other tests before making decisions about your medications.

Prior to your preoperative appointment, write down each medication you take. Don’t hesitate to ask your primary care doctor for a list of your medications, along with their dosages. The list should include:

  • Prescription medications
  • Over-the-counter medications (such as aspirin)
  • Herbs, vitamins, and supplements
  • Whether you smoke, and how often you drink alcohol or use other recreational drugs

Give the list of medications to your anesthesiologist on the day of your surgery. Your preoperative nurse should also put a copy of the list in your chart.

Day of Surgery: Why You Need to Fast After Midnight
Whether for a spine surgery or other procedure, you have likely been told not to eat or drink after midnight the night before surgery. Fasting was instituted as a preoperative rule to prevent pulmonary aspiration, which occurs when substances in your stomach move into your lungs. When this happens, it can obstruct airflow and increase the chance of developing serious infections. Fortunately, today’s anesthesia techniques have greatly reduced the risk of pulmonary aspiration. If you’re concerned about the fasting period, ask if there is any flexibility. You may be able to safely eat and drink sooner than the night before your surgery.

Fasting doesn’t just impact your meals—it also means you won’t be able to take some of your medications on the day of surgery. However, if you take blood pressure medication, anti-seizure medication, and acetaminophen-containing pain medications, your doctor may tell you to take them the morning of your spine surgery with a sip of water.

If you take insulin, talk with the doctor who prescribes your insulin about how to adjust it the morning of your operation, since you will likely not be eating. If you are not allowed to eat or drink after midnight, your doctor may recommend reducing the dose for the evening and morning before your procedure.

Table 1. Medications that May Affect Your Spine Surgery
medications and preoperative considerationsAdditional Medication Guidelines for Spine Surgery
The following medications often require special attention prior to surgery, as they may interfere with your body’s ability to stop bleeding. These medications and supplements, either as their direct mechanism of action or as a side-effect of them, reduce the ability to stop bleeding that occurs during and after surgery.

Blood Thinners
If you are taking any of the following drugs, do not stop taking them until you have a clear plan from your surgeon and your regular doctor. These often need to be stopped 1-2 weeks prior to surgery, but you may have to take shorter acting substitute medication instead.

A partial list of the more-commonly used medications in this category is shown in the table below.

Table 2. Blood Thinning Medications
types of blood thinners, generic and brand namesNon-Steroidal Anti-inflammatory Drugs (NSAIDs)
If you are currently taking any of the following NSAID products, you may have to stop using them 1-2 weeks before your surgery. Discuss with your surgeon and his/her medical team how soon to stop these prior to your surgery.

Table 3. NSAIDs
nonsteroidal anti-inflammatory drugs, generic and brand namesAspirin and Herbal Supplements
If you are taking any of the following aspirin products or herbal supplements, you will likely need to stop using them 1-2 weeks before your surgery. If you are taking any of these drugs to prevent stroke, heart attack, or blood clots, talk with your physician for the best course of action for you.

Table 4. Aspirin
aspirin and drugs containing aspirin, generic and brand namesHerbals and Supplements

  • Feverfew
  • Fish Oil
  • Garlic
  • Ginger
  • Gingko Biloba
  • Ginseng
  • Glucosamine
  • Green Tea

You Have a Medication Plan—Now Write It Down
Once you have your medication action plan approved by your doctor, write it down and keep it readily available (posted on your refrigerator, for example) so you don’t forget any changes from your typical regimen. Also, make sure you ask your doctor how long you need to adhere to your adjusted medication plan. Following your doctor’s recommendations will help keep you safe during your spine surgery and ensure a speedy, seamless recovery.

*These recommendations are general and may not reflect your condition and needs. Please follow your doctor’s specific recommendations for your medication use before, and after your spine surgery or nonoperative procedure.

Updated on: 02/23/17
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