This web page aims to give you a better understanding of these procedures. All procedures are a means to an end that is to improve function. Following epidural injection, your average pain score should decrease by 50% or more in the area treated or along the arms (cervical epidural) or legs (lumbar epidural). The effect may require one, two, or three injection treatments performed in sequence. The duration of pain relief is typically weeks to months, depending on the severity of the problem.
Why am I having this procedure?
The epidural space surrounds the outer covering of the spinal cord (dura) and extends from the skull to the tailbone. It contains fat, blood vessels and nerves that pass through the space after they leave the spinal cord.
Epidural injections are used to provide anesthesia during surgery, analgesia following surgery or are used for the diagnosis and/or treatment of pain due to inflammation in the epidural space.
How do I prepare for the procedure?
Please advise staff if you are:
Taking blood thinners (especially warfarin and clopidogrel)
Pregnant (or any chance of you being pregnant).
Allergic to iodine, betadine, shellfish, local anesthetics, or steroids.
Unwell (especially if you have an infection)
Staff may advise you to:
Fast for 8 hours prior to the procedure
Take your usual medications (apart from those mentioned above)
Arrange for someone to accompany you home
What does the procedure involve?
After arriving and completing the necessary paperwork:
- You will be asked to change into a hospital gown.
- A small cannula will be inserted into one of your veins. A bolus of saline fluid may be administered through the cannula.
- You may be given a mild sedative if you choose.
- Your heart rate and blood pressure will be monitored throughout the procedure.
- You will lie face down on an procedure table, the skin over the area to be injected is cleaned with an antiseptic solution, and the area is kept sterile.
- A local anesthetic is injected into your skin
- An light x-ray machine, called a fluoroscope, is used to guide a small needle onto the medial branch nerve.
- A special epidural needle is then inserted and directed towards the target area.
- An x-ray (radio-contrast) dye may be injected to confirm the correct location of the needle.
- The local anesthetic and anti-inflammatory solution is injected.
The procedure usually takes 10 to 20 minutes, plus recovery time.
What happens after the procedure?
- You will be monitored in a recovery area until you are ready to go home (usually 20-40 minutes).
- You may experience numbness and/or relief from your symptoms for several hours after the injection and you may experience some light-headedness on standing. These feelings will gradually return to normal over next few hours.
- It is preferable to have someone take you home and stay with you for the next 24 hours.
- If you have received any sedation during your procedure, the effects of these medications may last for up to 24 hours. You may not remember some of the information given during the procedure. This is a normal side effect of the medication. For the next 24 hours you should not drive a vehicle, drink alcohol, operate machinery, make important decisions, sign legal documents or travel unaccompanied.
- If you are given an epidural injection for the treatment of pain due to inflammation in the epidural space, you will be given a pain relief chart to fill out. Please bring this to show the doctor at your next consultation.
- Please remove the dressing the day after the procedure, when you next wash.
- The pain may return when the local anesthetic wears off. Some people experience an initial increase in pain and stiffness that may continue for several days. If necessary, an ice pack can be applied to the area, 20 minutes at a time, for 1-2 days following the procedure.
- Because of the way the medicines work, it may take several days for the benefits to be noticed. In more severe cases, the pain may actually increase temporarily due to a pressure effect of the medication. Additionally, you may feel flushed in the face and/or notice a change in your mood for a few days. Diabetic patients may notice a rise in their blood sugar levels.
- After the procedure, care must be taken to avoid a rapid increase in your activities. Gradually increase your daily activities as tolerated. Discuss this with your doctor.
- If you notice any swelling or bleeding from the site or have any other concerns, please contact the office, your Primary Care Physician, or the Emergency Department of your local hospital.
What are the risks of the procedure?
All invasive procedures carry the risk of complications. In general the risk is very low, but includes:
- Discomfort at the site of the injection.
- Worsening of your pain (usually a temporary “pressure effect” from the injection)
- Allergic reaction to the medications
- Difficulty in voiding may persist for 12-24 hours after the injection.
- Nerve damage (due to direct trauma, the medication, infection or bleeding)
- Steroid-related side effects such as transient flushing, mood swings, high blood sugar levels (especially in diabetic patients). The manufacturer did not specifically design most steroid solutions for this procedure. Despite this, these medications have been widely used, over many years, for this procedure without significant complications.
- In rare instances, bleeding into the epidural space can cause compression of the spinal cord, leading to paralysis at the level of the injection. Damage to the spinal cord and spinal nerves by the epidural needle are very rare complications.
What’s the deal with cortisone and steroids?
Cortisone, and other steroidal anti-inflammatory medications like it, have been used for decades to reduce the body’s production of inflammatory molecules when those molecules no longer help the body solve a problem but instead begin to attack and change the body. Unregulated or continuously produced inflammation from an area of injury or dysfunction can result in arthritis, scar tissue, and nerve irritation, to name a few. These powerful anti-inflammatory medications can have greater side effects on the body when taken by mouth since a relatively large dose is required to treat a small area of the body. There is some concern that repeated use of steroid shots may cause deterioration of the cartilage, bone or tendons. Therefore injections of a particular type and location are typically limited to six times per year when steroids are used.
Is there an alternative to using steroids?
YES! New data suggests that injection with local anesthetics alone may be as effective as with steroidal anti-inflammatories. However, further research must be done. Additionally, in our practice, we also use the natural, plant-based anti-inflammatory agent called Sarapin in all of our injections. Even if the steroid is eliminated there is still some potential anti-inflammatory benefit from the Sarapin, although this has not been as widely studied and accepted as the use of steroids.