Epidural Injection

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What is an Epidural Injection?

The nerves that are responsible for your pain are located in an area surrounding the spinal cord called the epidural space. The epidural space extends from the back of your head to the bottom of your tail bone, and injections can be done at any level depending on where the problem is. Caudal epidural injections are done at the bottom of the tailbone (sacrum), Lumbar injections are done in the low back, Thoracic injections are done in the middle back, and cervical injections are done in the neck. The injection directs medication into this space as a means of relieving pain.

How does it work?

Epidural steroid injections are used to try to help reduce inflammation around the spinal nerve roots in the spine thereby reducing the severity of the pain. The mixture enters the epidural space, and spreads around to the area to where the nerve irritation/compression is taking place in your back. Injecting depot steroids into the epidural space is an unlicensed use of the drug. However there is a body of medical evidence that suggests that this treatment can be beneficial for those with nerve root irritation.

What happens?

  • A small needle is placed in the back of your hand for sedation or emergency drugs.
  • You will either be sitting, lying on your front or side.
  • Your back is cleaned. The skin is numbed with some local anaesthetic is injected which stings a little first.
  • The epidural needle will pass through the numb skin, between the bones of your spine and into the epidural space under x-ray guidance.
  • Contrast dye is injected and is viewed by x-ray to confirm correct needle location and determine the location of disease where possible.
  • A mixture of local anaesthetic and steroid (unlicensed steroid use) will be injected with the epidural needle, after which the needle will be removed.
  • Depending on the technicality of the procedure and your medical condition, you may be offered a pain killer or sedative as agreed with your doctor.

Possible side effects and complications:

  • Local soreness or bruising at the injection sites, worse pain for a few days likely due to muscle spasm.
  • Temporary numbness / weakness due to the local anaesthetic agent spilling too near a leg nerve. This usually fades within 2-3 hours. In exceptional cases you may be required to stay in hospital overnight.
  • Temporary drop in blood pressure.
  • Temporary urinary retention.
  • Post Dural puncture headache.
  • Total spinal injection.
  • Epileptic seizures.
  • Damage to the spinal cord and spinal nerves.
  • No pain relief.
  • Infection – minimised by performance as a sterile procedure.
  • Stroke – Very rare.
  • Bleeding.
  • Anaphylaxis – severe allergic reaction any of the medications used.
  • Nerve or Spinal Cord Damage – very rare.
  • Steroid effects – may include menstrual disturbance but will settle and usually no action needs to be taken. If you are diabetic, the steroid injection may upset your sugar control for at least one week.