Epidural injections are commonly used in treatment of cervical, thoracic, and lumbar back pain as well as radicular leg pain. The major goal of this particular type of injection is pain relief. This injection delivers steroids directly into the epidural space in the spine and directly to or near the source of pain generation. The epidural space surrounds the dural sac that surrounds the spinal cord, nerve roots, and cerebrospinal fluid. In contrast, oral steroids/pain medications are spread in a less-focused manner and may have potential unwanted side effects.
In general a solution combining a steroid, such as triamcinolone, dexamethasone, and methylprednisone, and a local anesthetic, such as lidocaine or bupivacaine is used. The purpose of the steroid use is to inhibit the inflammatory response caused by the chemical or mechanical sources of pain. Additionally, steroids act on the immune system by reducing its reaction to the inflammation associated with nerve and/or tissue damage.
Prior to the procedure the patient is offered the choice to take a Xanax for anxiety an hour prior to coming in. This is not a necessity, but only used to help ease the anxiety the patient may be feeling prior to the injection. The patient will also need a driver to and from the office for the injection. Additionally the patient must stop either Coumadin or Plavix if they are taking it, but only as directed by their physician.
On the day of the injection, the patient will be asked to change into a gown, which allows the doctor access to the area of the back to be injected and to clean the area. This injection typically lasts between 15 to 30 minutes. The patient lies down on the table and the area of the back to be injected is sterilized with betadine, which may present as a cold sensation on the area. The area is then numbed with a local anesthetic at the two levels that will be injected. Then under fluoroscopy (live xray) a needle is inserted into the anesthetized area and into the epidural space. A small amount of contrast die is injected into the area to confirm proper location and good spread of the medicaiton. After confirmation the steroid/anesthetic combination is injected into the joint.
Patients typically only feel a pinch and sting associated with the administration of the numbing medication, but only pressure with epidural needle insertion.
After the injection the patient may feel tenderness at the site where the needle was injected, which can be treated by applying an ice pack for 10 to 15 minutes. The patients are also asked to take it easy for the rest of the day and normal activities may be resumed the following day. There is a chance that the patient may feel an increase in pain in the area over the next few days, due to increased pressure from the injected fluid but this should resolve.
It can also be noted that patients seem to have a better response from the injection when it is used in combination with therapeutic exercises and a series of injections may also be necessary to provide sufficient relief.
For more detailed information or questions please contact your doctor. This information is not to be substituted for medical advice.
please contact our main office at (239) 591-2803.