Epidural Injection

What is an epidural injection?

An epidural injection is used to relieve pain in your spine. There is an area in the spine that surrounds the nerves. This is called the epidural space. You will get an injection (shot) of a steroid into this space. You may have anesthesia injected as well. Low-dose x-rays are used to find the exact location for the injection.

During the injection you will need to lie on your stomach. X-rays will be taken to help the doctor locate where the needle should enter the skin. This spot will be cleaned and marked. The doctor will inject local anesthesia to numb your skin. Then, a small amount of x-ray dye will be injected. This makes the x-ray picture clearer helping make sure that the doctor is in the correct spot. Next, the steroid will be injected into your spine. Any of these injections may cause mild pain. Although this may be uncomfortable, the pain means there is a good chance that the epidural injection will work.

Why do I need an epidural injection?

These injections may be used to:

  • relieve pain from some medical conditions (herniated disc).
  • manage pain before surgery.
  • manage pain if you are not medically able to have surgery.

What do I need to do before the epidural injection?

Continue taking all your medications unless your health care team gives you different instructions. On the day of the injection, take any medications with small sips of water. You may need to stop taking blood thinners (Coumadin®, Heparin®, Lovenox®, Ticlid®, Plavix®). It is important to discuss this with your health care team before scheduling your epidural injection.

Tell your health care team if you are allergic to x-ray dye or iodine. It is also important to tell your health care team if you have kidney problems, diabetes and/or if you are pregnant.

What happens after the injection?

After you get the injection, you will be taken to the recovery area. You will be able leave the hospital as soon as you can stand and walk. It is possible that you will have some weakness in your legs. Your health care team will monitor you until the weakness goes away.

Note: It is best to have someone with you to help you get home.

Before you leave, we will give you written instructions about how to take care of yourself when you get home and also about any follow-up appointments. We will give you a pain log and show you how to fill it out. It is important to keep track of your pain for 1 week after your injection. Bring the log with you to your follow-up appointment. By looking at your pain log, your health care team can see if the injection is working.

What should I do when I get home?

It is important to drink a lot of fluids. The dye injected with the steroid does not stay in your body. You will get rid of the dye when you urinate (pee). The more you drink, the faster this will happen.

Keep the injection site clean and dry for at least 24 hours. There will be a bandage over the area where you had the injections. You can remove the bandage after 2-3 days if it does not fall off on its own. The site may be sore. You can use either ice-packs or heat -packs to help with the pain. You may also take Tylenol® or any NSAID (non-steroidal anti-inflammatory agent) such as Motrin®, Naprosyn®, Alleve®, Celebrex®, Vioxx® or Bextra®. Ask your health care team how much you can take and how often.

Remember, you had anesthesia injected in your spine. This means you may still be numb and not feel back pain. The anesthesia should wear off in 1- 6 hours. Pain you felt before your epidural injection may return and could be slightly worse for a short time.

The steroid usually begins to work 2-3 days after the injection. It may take as long as 1-2 weeks for the steroid to work.

Limit activity for 1-2 days. Your health care team will give you more detailed instructions. It is important to follow these instructions even if you are no longer feeling pain.

WARNING FOR PATIENTS WITH DIABETES:

Steroids increase blood sugar. This may make it more difficult to control your sugar levels. If you take medication for your diabetes, this medication may not control your sugar as usual. High blood sugar can cause an infection. It is important that you check your blood sugar level more often for several weeks after your epidural injection. If your sugar level is high, call your diabetes doctor right away. Your doctor may need to give you medication or adjust your medication to help manage your blood sugar.

What are some side-effects of the epidural injection?

There are some rare but serious side effects of an epidural injection.

  • It is possible that your pain will be worse for a short time during and after the procedure. The pain should go away. The amount of time this takes will be different for every person. There are pain medications that may keep you more comfortable. Ask your health care team which one(s), how much and how often.
  • We are trying to inject the dye and steroid solution into a very small space that is close to other areas of your spine. If the injection goes into another area, we will stop the procedure and remove the needle. We will ask you to come back in 7 – 10 days to try the procedure again. We do not want the steroid to go into any other areas. This may make your pain and swelling worse.
  • You may have some bleeding in your spine during your epidural injection. This does not happen often. Your health care team will monitor the bleeding. The side effects from this bleeding may go away quickly. Very rarely, the side effects from the bleeding get worse. If this happens you may need surgery to stop the bleeding or to remove a blood clot.
  • It is possible for the spine to become infected. This is rare but serious. The infection would be treated with antibiotics. Tell your health care team right away if you have any pain, swelling, red skin or fever that lasts for 3 or more days after the injection.

NOTE:

Each injection contains only a small amount of steroids. This helps to make sure the steroids stay in and affect only the area close to the injection. This also reduces the risk of side effects. It is possible that some of the steroids will travel through your body. Large amounts of steroids may be dangerous so it is best that you do not have steroid injections more than 4 times a year.