Epidural Steroid Injections

Epidural steriod injections, are performed to confirm a specific diagnosis and/or to help decrease pain, swelling, and inflammation associated with an affected nerve root. The site of the nerve irritation is most often within the bony spinal column just outside the spinal cord, in the portion of the bony spinal canal known as the epidural space. The epidural space communicates with the spinal disc, nerve roots, spinal or ‘facet’ joints, and the tissues which hold them together. Any or all of these structures may be responsible for spinal pain and associated leg or arm pain.

An epidural injection involves injection of steroid medication, usually combined with local anesthetics or ‘novocaine’ type drugs into the epidural space where they can exert their pain relieving effects.

The epidural injection is performed just inside of the bony component of the spinal column. This injection may help the injury to heal by reducing inflammation and may provide pain relief while the injury/cause of pain is healing. For example, in the case of sciatica or leg pain from a herniated disc, studies have shown that the typical duration of benefit for treatment with epidural injection is around three months. Since many sciatica symptoms may resolve in 3-6 months, a series of epidural injections may be all that is needed to provide excellent relief of pain symptoms during the period necessary for natural healing. While there are no guarantees that extended pain relief or resolution of the problem will occur, many obtain relief from this procedure.

Epidural injections also provide a convenient means of testing pain medications that may later be delivered into the body by intraspinal pain pumps for the long term treatment of serious pain problems in some cases. Pain relieving drugs may be introduced into the epidural space in a variety of ways, depending on individual patient requirements.

Epidural steroid injections can be safely performed on an outpatient basis. The skin is always numbed with local anesthetic before careful placement of specially designed small gauge epidural needles. If needed, an I.V. will be started and sedation and other medications will be given. The skin overlying the site of injection is cleaned with antiseptic solution, and covered with sterile drapes.

For some procedures, as determined by doctor, x-ray (fluoroscopy) may be employed to ensure exact placement of the medication as close to the site of the problem as possible. Radiocontrast dye is injected first to confirm the spread of medications in the inftended location unless allergy to these agents is known or suspected, before any therapeutic medication is injected.

At the completion of the procedure the needle and any catheters used to direct the placement of medications are withdrawn and a band-aid dressing is applied.

For some patients, the epidural catheter will be left in for a few days for a trial of intraspinal medications to determine if a pain pump will be implanted at some future date. In addition, contrast (dye) is injected first to better visualize the anatomy and confirm proper location.

The procedure typically lasts less than 15-30 minutes followed by 20-40 minute recovery.

Post-Procedural Care and Follow-up:

Some of the common recommendations are listed below. However, since the requirements for each patient is different, the University Pain Clinic team may give you specific instructions. As always, feel free to ask our staff if you have any additional questions or concerns.

Avoid being on your feet for 2-3 hours following the epidural injection, and do not drive or operate dangerous equipment or machinery during this time.

• Notify the UPC staff if you experience persistent pain at the injection site, headache that is worse when sitting or standing upright, fever, chills, dizziness, or leg or arm numbness that lasts more than 2-3 hours.
• A drop or two of blood at the injection site is normal. However, you should contact the UPC office if you experience persistent bleeding or drainage at the injection site and then follow all of their instructions for further care.
• Results from the injection usually occur within 2-5 days and you may experience continued improvement over the next several days. Full benefit may take longer (ie two weeks). The UPC Pain specialist will instruct you regarding whether you should take any other pain medications during this time.
• Contact the UPC staff if you have any additional questions or concerns.

GLOSSARY:

EPIDURAL - Space outside the dura or covering of the spinal cord. This space runs the length of the spine (see diagram).

FLUOROSCOPY - X-ray imaging of a part of the body that is displayed on a screen or monitor in the block suite.