What is an epidural injection?
An epidural injection is an injection of drugs into the epidural space. The epidural space lies between the dural sheath, which surrounds the spinal cord, and the contents of the spinal canal within the back. This can be used to treat pain that radiates down into the arms or legs when your doctor thinks that this pain has started in the spine.
Why perform an epidural injection?
An epidural injection is performed in order to get specific drugs, such as steroids, as close to the nerve roots as possible. When there is a problem with one of the discs in the spine, it can release irritant substances which cause inflammation of the nerve root, which is why there is pain in the leg or arm. Steroids are injected and these will help to reduce the inflammation of the nerve root, and help to reduce the pain.
This use of steroids is outside the licensed indication for their use. The license of a drug indicates for which treatments the manufacturer can sell it. Doctors are free to use a drug for whatever purpose they consider it appropriate, as long as there is evidence to support that use. The use of epidural steroids has been practiced for many years and it has been shown to be an effective treatment for arm pain due to disc disease. Especially when considering that an alternate treatment such as surgery poses more risk.
If you are taking a blood thinning medication you must let us know beforehand as this increases your risk tremendously. We will discuss your options to optimize the safety of this procedure.
Can anyone have an epidural?
Most people can have an epidural. If you have any localized infection, such as a skin infection in the area around the injection site, or a generalized infection, the procedure would not be performed until the infection has cleared up. This is for your own safety as having an infection on the day of the procedure can cause a worsening of the infection.
The procedure is done under live X-ray to ensure that the injection is given in the correct place. If you are female and below the age of 55 you will be asked about the date of your last period, and you may be asked whether you are likely to be pregnant. Although the amount of radiation used is small, there is always a risk to the fetus with radiation. Occasionally we may need to ask you to have a pregnancy test.
The procedure cannot be done on anyone who has a problem with their blood clotting. Most commonly this is due to taking blood-thinning medication.
If you are taking a blood thinning medication you must let us know beforehand as this increases your risk tremendously. We will discuss your options and optimize the safety of this procedure.
What are the risks and complications?
The most common problems relate to local anesthetic which may be used. This is injected into the epidural space to confirm that the injection has reached the appropriate nerves, so there may be some numbness and weakness of the legs.
Because the local anesthetic has an effect upon the nerves which supply the blood vessels in the legs, and makes them relax, there may be a fall in blood pressure which is associated with a feeling of faintness and nausea. This can be treated quite easily by giving fluid or drugs to reverse this effect.
Headache may occur in one percent of patients who have an epidural. This is due to the inadvertent puncture of the dura. This can be treated and is rare but does occur.
Infection is always a risk whenever anything is injected into the body, and we take precautions to avoid this by performing the procedure as a fully sterile technique. If an infection does occur it can produce the symptoms of feeling unwell, headache, and stiffness of the neck. This can occur quite soon after the injection.
There is the possibility of an abscess forming in the epidural space, which may occur after two or three days, and would give rise to pain in the back and worsening pain in the extremities. Similar symptoms may occur if there is a blood clot within the epidural space. This is more likely to occur if you are taking medicines to thin the blood. Overall, these complications are extremely rare.
However, if you start to suffer from any of these symptoms, you must go and see your doctor or the Emergency Room of your local hospital urgently (do not go to Urgent Care), and inform them that you have had an epidural injection.
How is the procedure performed?
The procedure is performed in the operating room or office under live X-ray. When you arrive a small needle may be inserted into one of your veins, for safety, so that should any drugs be
required, they can be easily given. You will be expected to lie on the table face down.
Local anesthetic is injected into the skin and deeper tissues to reduce the discomfort of the procedure. However, when the needle is inserted there will be a feeling of someone pushing in
your back or neck, which is normal. When the operator has put the needle in, X-rays will be taken to confirm that the needle is correctly positioned. When the operator has confirmed that the needle is in the correct place, the injection will be given and the needle removed.
What happens after the procedure?
After the procedure you will go into the recovery area where your blood pressure will be monitored. As local anesthetic is normally used as part of the injection technique, you may notice some numbness or weakness of your legs. This is only a temporary problem, which will wear off. Therefore you will not be allowed to go home until you have full sensation in your legs.
What pain might you experience after the procedure?
The amount of pain experienced might become worse for a short period of time. If this occurs, it is not dangerous and should settle over time.
Back at home
You can remove the dressing from the injection site after 24 hours.
Will you be followed up afterwards?
You will be called for follow up to determine how the epidural has helped you.
Important information
Please let us know before if you have:
A cold/flu
Fever/chills
A persistent cough
You are taking a course of antibiotics prior to procedure Or there has been any significant change in your overall health as this may affect your procedure.
Failure to do so may result in your procedure being cancelled on the day.
Medication
Please take all your prescribed medication as normal prior to your procedure unless you have been otherwise advised
Please bring a list of all your current medication when you attend your procedure
Can I eat before I come in?
If you plan to get sedation for the procedure you should not eat from midnight the night before.
If you have any questions or concerns about this procedure call the office at 480-444-7480
This handout should not be considered more important than your doctors advice when you spoke to him in the clinic. The information contained in this is generalized and may not pertain to your specific condition.
