An epidural steroid injection is an injection of an anti-inflammatory steroid in the epidural space. The epidural steroid injection is not an injection into the spinal cord itself. The spinal cord and spinal nerves are in a “sack” containing clear fluid (cerebrospinal fluid). The area outside this “sack” is called the epidural space. An epidural steroid injection is not the same injection as a labor epidural, which is commonly given to women in labor.
When the nerves in the epidural space are irritated or pinched by a bulging disk, narrowed “nerve canal” or bone spur, the resulting inflammation can cause pain, numbness, or tingling. The steroid injected can reduce inflammation of nerves in the epidural space and thus reduce pain and other symptoms.
The actual injection takes only a few minutes. Please allow about 3 hours for the procedure; this will include talking to your doctor before the procedure, signing the informed consent, positioning in the room, and observation by the recovery room nurse afterwards.
The injection consists of a mixture of local anesthetic and the steroid medication.
All of our procedures begin by injecting a small amount of local anesthetic through a very small needle. It feels like a little pinch and then a slight burning as the local anesthetic starts numbing the skin. After the skin is numb, the procedure needle feels like a bit of pressure at the injection site. You also have the option of adding some oral or intravenous sedation.
You can choose to have the procedure done under local anesthetic only. You can also choose to have IV sedation, which can keep you very comfortable. It can range from some drowsiness or you may have little or no memory of the procedure depending upon your comfort level, regardless of the amount of sedation, you must not eat or drink anything for 6 hours prior to this and you must also have a driver when choosing sedation. It is OK to take your medications with a sip of water with either decision.
It is typically done with you lying on your stomach. Your blood pressure and oxygenation will be monitored. In addition to your doctor and the x-ray technician, there will be a nurse in the room at all times if you have any questions or discomfort during the procedure. The skin on the back is cleaned with antiseptic solution and then the procedure is done.
Immediately after the injection, you may feel your legs becoming slightly heavy or numb. You may notice that your pain may be gone or considerably less. This is due to the effect of the local anesthetic and lasts only for a few hours. Your pain may return and you may have some soreness at the injection site for a day or so. You should start noticing pain relief starting about 1-2 days after the procedure.
We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Your recovery room nurse will advise you about applying ice to the site.
You should be able to unless the procedure was complicated. Your doctor or recovery room nurse will discuss this with you.
The long-term effect of the medication cannot be predicted. Usually, the immediate effect is from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about 2-7 days and its effect can last for several days to a reasonably long time.
The typical series of injections is for about three, spaced about two weeks apart. You should expect a gradual overall improvement in pain after each injection. However, if the pain is gone after an injection, you would not need another injection unless some or all of the pain comes back. Your doctor may also help advise you about this.
After the first series of three injections, you would need to wait at least 6 months to a year before you could have more.
Overall, this procedure has very few risks. However, as with any procedure, there are some risks and side effects you should know about. Commonly encountered side effects are increased pain from the injection (usually temporary), rarely inadvertent puncture of the “sack” containing spinal fluid (may cause headaches), infection, bleeding, nerve damage, or no relief from your usual pain. Side effects of the injected steroid are generally temporary and may include feeling sweaty and red faced for a few days, temporary weight gain, a short term increase in blood sugar (mainly in diabetics) if you take medication for diabetes your doctor may need to advise you about medication adjustment, you can discuss the steroid medication more completely when you come in for the procedure. Some people experience flushing, sweatiness and/or palpitations for few days afterwards.
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