Epidural Injections

Lumbar, Thoracic, Cervical and Caudal Epidural Injection

What is an epidural injection?

The epidural space in the back is the area that wraps around the spinal cord as well as the nerves that exit out of the spinal cord. An epidural injection is simply an injection of medications into this space. The epidural space is just inside the spinal canal and extends from the neck all the way down to the base of the tailbone.

What is the purpose of an epidural injection?

The purpose of an epidural injection is to often decrease negative symptoms, such as pain, numbness, tingling and inflammation/swelling around exiting spinal nerves. long acting steroid injected reduces the inflammation and swelling of spinal nerves and other surrounding tissues in the epidural space.

Am I a candidate for an epidural injection?

Epidural injections are safe, common, and versatile in application. They can help with nerve root pain in the arms and the legs caused by disc herniations, degenerative disc disease, spinal stenosis, certain neuropathies, reflex sympathetic dystrophy and other conditions. Epidural injections are typically part of an overall treatment plan, also utilizing adjacent treatments such as oral anti-inflammatory medications and physical or chiropractic therapy.

How long does the epidural injection take?

The actual epidural injection usually takes anywhere from 5-10 minutes.

What is actually injected?

The injection typically consists of plain saline mixed with a combination of long acting steroid medication and/or local anesthetic.

Will the epidural injection hurt?

An epidural injection involves accurate needle placement in the epidural space, which requires a needle going through the skin and deeper tissues. To maximize your comfort, however, we offer intravenous sedation and local anesthetic at the skin and in deeper tissues before inserting the epidural needle, making the entire procedure much easier to tolerate.
In most cases, you usually you feel more of a strong pressure as the needle advances and not as much sharp pain.

Will I be “put out” for the epidural injection?

No. An epidural injection is done under local anesthesia (numbing medicine) and intravenous sedation. The intravenous medication is titrated to effect while the numbing medicine and needle is being placed. Some patients may actually experience amnesia and may not remember some, or any, parts of the procedure.

How is the epidural injection performed?

You will likely be laying on your belly during an epidural injection. Monitors are placed and patients can then be sedated. The skin is cleaned with antiseptic solution, the needle entry site is numbed and the injection is performed under x-ray guidance.

What should I expect after the epidural injection?

On the same day as your injection, you may not feel much different than before your injection. You may feel numbness at your injection site, soreness or an ache for a couple of days. This is simply due to the procedure itself. You should start noticing significant pain relief starting around 2-3 days after the procedure.

What should I do after the epidural injection?

On the day of your epidural injection, please have someone designated to drive you home. You will take it easy and rest for the remainder of the day. We recommend you only perform light activities that you can tolerate. After a day or so, you may increase your activity level slowly.
However, most patients can perform any activity that they could perform before the procedure.

Can I go back to work the next day?

Unless your procedure was difficult or had a complication, you should be able to go back to work the day after your epidural injection.

How long does the effect of the medication last?

The long acting steroid starts working in about 48-72 hours after the injection and its effect can last for several days to months.

How many epidural injections do I need to have?

It depends. If you do not get relief from your first injection within two weeks, we often recommend a second injection. Similarly, if you get partial or incomplete relief on a second injection, you may need a third.

Can I have more than three epidural injections?

In any given six-month period, most patients do not receive more than three injections. This is because the medication injected lasts for six months or more.
If, after three injections, you have not obtained significant relief, it is not likely you will benefit from further injections and the risks of side effects of the injections may begin to outweigh the benefits. However, if a patient gets six months or more of significant pain relief from a series of epidural injections, injections may be repeated again in the future.

Is an epidural injection the same thing that women have for labor pain?

Although there is some similarity, these two procedures aren’t exactly the same. Both procedures target the epidural space. With labor epidurals, we use a larger needle and thread a catheter that remains in the epidural space throughout labor. The dosage of medication given through the epidural catheter during labor helps with labor pain, but often often causes weakness and difficulty walking. Epidural injections we perform, however, rely primarily on a long acting steroid for pain relief by decreasing inflammation around the nerve. We strive to give very little, if any, local anesthetic in our injections to minimize weakness of the arms or legs after your procedure.

Will the epidural injection help me?

The purpose of the injection is to help alleviate pain generated by nerves exiting your spine. However, It is sometimes difficult to predict if the injection will help you or not.

For instance, patients who have pain that radiates from the neck/back down into the arms/legs from irritated spinal nerve roots respond better to epidural injections than patients who have only neck or back pain (otherwise known as “axial” pain). In the same light, patients who have more recent onset of symptoms will respond better to epidural injections than those who have lived with longstanding pain. And if there are bony abnormalities in the spine, the level of relief a patient experiences can vary quite a bit.

Are caudal blocks and saddle blocks the same as epidural injections?

A caudal epidural injection is an epidural injection that is delivered through the tailbone or sacrum. Basically, we enter the epidural space through the base of the spine.

If sufficient local anesthetic is used in the injection, it may cause a saddle block, which refers to numbness around your pelvis, groin, buttocks and midsection.

What are the risks and side effects of epidural injections?

In general, epidural injections are extremely safe. However, all procedures come with risks, side effects and potential for complications. Some common complications and temporary side effects include soreness, bruising, and pain at the injection site. On an even rarer instance, if there is a spinal puncture during the procedure, you may experience a headache that will subside over time and may require another procedure called a blood patch. Uncommon risks also include infection, bleeding inside and outside the epidural space, nerve damage or worsening of original symptoms. There are potential risks also related to the side effects of the long acting steroid which is injected for pain relief, including weight gain, increase in blood sugar, water retention or suppression of body’s own production of steroids.

Who should not have an epidural injection?

Patients who have an allergy to any of the medications that are injected, are on blood thinners as a part of their medication regimen, have an active infection or have poorly controlled diagnoses such as diabetes or heart disease may not be good candidates for an epidural injection and may have to be postponed until their medical condition improves.