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Epidural Steroid Injections

What is an Epidural Injection?

An epidural injection is a specialized procedure given by the Pain physician. The injection places anti-inflammatory medication (steroid) into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your back, arms, or legs. It may provide a period of pain relief of several weeks or months. Some patients get permanent relief. The injection may also assist in the diagnosis of certain pain syndromes.
What will happen to me during the procedure?

The actual procedure may take 15-20 minutes. The location of the injection will depend on the location of your pain. Depending on your doctor's preference, x-ray guidance may be used. You will be positioned either on your stomach or in the sitting position. Try to remain as relaxed and still as possible. The doctor will scrub your back with sterile soap to reduce the chance of infection. Next, the doctor will numb a small area of skin on your back with numbing medicine (lidocaine), and this may sting for a few seconds. After the numbing medicine has taken effect, the doctor will direct the needle into the epidural space. A small amount of contrast dye may be injected to confirm proper needle placement. Then, the steroid will be injected and the needle will be removed.
What will happen to me after the procedure?

A nurse will monitor you for approximately 15-20 minutes. You may feel brief nausea, sweating, and/or dizziness. Your legs may feel weak or numb for a few hours. You should avoid driving or operating heavy machinery until you are back to normal strength and sensation. You may have tenderness, slight swelling, or bruising at the injection site. All of these sensations are temporary. Once you are stable, you will be discharged home with additional instructions and a follow-up appointment.
What are the risks and complications?

As with any procedure, there are risks or complications. These are rare but we are prepared to treat them immediately. Should any of the following problems occur, you may be required to be admitted to the hospital for overnight observation:
1. Allergic reaction causing difficulty breathing from swelling of the air passages.
2. Loss of consciousness and total body numbness from an unplanned injection of the anesthetic medication into a blood vessel or spinal canal.
3. Seizure from an unplanned injection of the anesthetic medication into the spinal fluid or blood vessel.
4. Bleeding or infection in the epidural space or spinal canal. This complication may require surgery.

General Instructions:

1.      Before the procedure, report the following to your doctor or nurse:

  • Allergies, especially to numbing medicine (such as novocaine or lidocaine), iodine, betadine, x-ray dye, or shrimp/seafood
  • Blood thinners (Plavix, Coumadin, Aspirin)
  • Diabetes
  • Pregnancy

2.      Please take your routine medications on the day of the procedure. If you take  Coumadin, we will get permission from your doctor to stop this medication 5 days before your injection. You will need to have a blood test performed to make sure your blood will clot normally. If you take Plavix, Aggrenox, or regular-strength aspirin, you will be asked to stop this medication one week (7 days) before your injection.

3.       You will need to bring a driver with you on the day of the procedure to drive you home me.

4.      You may return to your regular activities the next day.

5.       Once you are home, we will ask you to watch for signs of infection at the injection site. The key warnings are: fever, redness, swelling, increased pain, drainage (white-yellow-green with or without a foul odor). Please call our office or the on-call Anesthesiologist if you have any of these symptoms.

6.      You may have a short-term increase in your pain as a result of irritation from the steroid injection. You may apply ice to the area if needed.

7.      If you have any other questions, please call our office for additional information.

 


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