Epidural injections are a non-surgical treatment to help relieve low back and leg pain. It goes into your “epidural space,” which is right outside of the membrane that protects your spinal cord. Doctors use epidural injections to relieve pain during and after surgery, as well as managing chronic pain.
A spinal epidural injection places anti-inflammatory medicine into a specific region of the spine’s epidural space. The medication helps decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
The membrane that covers the spinal cord and nerve roots in the spine is called the dura mater, a protective type of tissue. The space surrounding the dura mater is the epidural space. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.
Illustration shows many spinal structures including, the third and fourth lumbar (low back) vertebrae, spinal cord, subarachnoid space, and epidural space.
The membrane that covers the spinal cord and nerve roots in the spine is called the dura mater, a protective type of tissue. The space surrounding the dura mater is the epidural space. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.
An intravenous line (IV) is started so that relaxation medication can be given. The patient is placed lying on their side on the x-ray table and positioned in such a way that the physician can best visualize the low back using x-ray guidance (sometimes called fluoroscopy).
The skin on the patient’s back is scrubbed using 2 types of sterile scrub (soap). Next, the physician injects a numbing medication into the skin area where the epidural injection will be administered. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into the spine’s epidural space. A small amount of contrast (dye) is injected to ensure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anaesthetic) and anti-inflammatory (cortisone/steroid) is injected.
The patient is returned to the recovery area where they are monitored by medical staff for 30-60 minutes. Prior to discharge, the patient is asked to record their levels of pain relief during the next week using a post-injection evaluation sheet (“pain diary”).A follow-up appointment will be made for a repeat injection pain block, if indicated.
Depending on the patient’s level of pain relief, another injection may be administered in 2 weeks. The patient’s back or legs may feel weak or numb for a few hours. This is to be expected, but it does not always happen.
A few hours before the procedure, the patient may be allowed to eat a light meal. If the patient has type 1 diabetes, they must not change their normal eating pattern prior to the procedure. Patients may take their routine medications (eg, high blood pressure, diabetic medications).
Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients should be in pain prior to this procedure, so it’s important not to take medications to relieve or lessen pain. These medicines can be restarted after the procedure if they are needed.
In general, the patient is asked to be at the outpatient facility one hour prior to the procedure and can expect to be at that facility approximately 2-3 hours. Someone must accompany the patient and be responsible for getting them home. No driving is allowed on the day of the procedure. Patients may return to their normal activities the day after the procedure, including returning to work.
Talk to your doctor about your risk for complications.
Your doctor will most likely have ordered an MRI or CT scan of the back before this procedure. This helps your doctor determine the area to be treated.
Your pain may become worse for 2 to 3 days after the injection before it begins to improve. The steroid usually takes 2 to 3 days to work.
If you receive medicines to make you sleepy during the procedure, you must arrange for someone to drive you home.
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