An epidural injection is an injection of medication, usually a corticosteroid and anesthetic or narcotic, into the epidural space. The epidural space is within the spinal canal between the bony vertebrae and the spinal cord. The space is filled with fatty tissue, veins and arteries. The fatty tissue acts as a shock absorber and barrier to keep the spinal cord from coming into contact with the bony vertebrae.

A corticosteroid is a powerful and long-lasting anti-inflammatory medication that helps to calm irritated and swollen nerve roots and aids healing. The anesthetic or narcotic provides temporary pain relief. Epidural injections can be administered at a clinic, outpatient center, or hospital. Many physician specialists are qualified to perform injection procedures, including anesthesiologists, radiologists, neurologists, physiatrists and spine surgeons.

Potential Benefits

Spinal epidural injections can be important to your diagnostic process and treatment program. Epidural injections offer patients two potential benefits:

1. Reduce inflammation of the nerve roots and ease symptoms.
2. Provide diagnostic information about the cause, location and/or pain source

Epidural injections may be given to treat cervical (neck and arm) pain or lumbar (back, buttock and leg) pain when nerve compression or damage is suspected. Pain relief from an epidural injection is often temporary and may last one week to one month. The injection may be of particular benefit during an acute pain episode and provide the patient with enough relief to participate in physical therapy and/or rehabilitation.

Depending on the outcome of the first injection, a second epidural injection may be administered. If the first or second epidural does not produce good results, seldom is a third injection given. Because a spinal epidural injection includes a steroid (corticosteroid), the number of injections allowed each year is limited to help prevent and minimize steroid-related side effects such as loss of bone density.

Possible Complications

An epidural injection, like other medical procedures, may present risks. Complications include bleeding, risk of infection, low blood pressure, headache, injury to nerve tissue and/or allergic reaction to medication or contrast media.

Some patients should not undergo a spinal epidural injection. Restrictions or precautions include:

• Allergy to the contrast medium and/or drugs to be injected
• Anemia
• Significant asthma
• Bleeding problems
• Infection
• Kidney disease
• Pregnant or breastfeeding
• Severe spinal abnormality

Patient Preparation: Current Medication

• Tell your doctor about all prescription medication you take, including over-the-counter drugs. Some types of drugs, such as blood thinners or certain medications that treat diabetes, must be discontinued before your procedure. Below is a short list of common instructions. Your doctor will provide a more specific list for you.
• Stop blood-thinning medication two days prior to the test
• Do not take any aspirin products five days prior to the test
• Stop anti-inflammatory medication five days prior to the test
• Stop pain medication eight hours prior to the test
• Do not eat or drink six hours prior to the test
• Arrange for someone to drive you home
• Your doctor may have you discontinue anti-inflammatory or pain medications before the procedure to more accurately determine the amount of pain relief you get from the injection. This is important for your diagnosis.

Patient Preparation: At the Medical Facility

The medical staff reviews your history, condition, medications, allergies and other pertinent information.

• You change into a gown.
• An IV (intravenous) line may be started in your arm (or hand), and you may be given medication to help you relax.

What to Expect During the Procedure

Overview: The procedure is performed using fluoroscopy to guide needle placement into the epidural space. Fluoroscopy allows the doctor to see the procedure, similar to a real-time X-ray. When the needle tip is positioned at the target area, a small amount of contrast agent (dye) is injected into the area to confirm the medication will flow correctly into place. Once confirmed, an anesthetic and corticosteroid medication is injected.

• For a lumbar injection, you may be asked to lie face down with cushions to help keep you comfortable or positioned in a chair or by the bedside.
• For a cervical injection, you may be positioned face down with cushions to help keep you comfortable.
• The skin around the injection site is cleaned and prepared. A local anesthetic numbs the skin around the injection site. Although a local anesthetic stings, it helps to make the epidural injection more comfortable.
• Using fluoroscopy (real-time X-ray), the doctor guides the needle into the epidural space and injects a small amount of contrast agent. The contrast shows up on the fluoroscopic image so the doctor can confirm the medication flows into the target area. Then, the medication, which is also visible on fluoroscopy, is injected. It is normal to feel pressure or pain as the medication is injected.
• After the injection, the needle is removed, and a small bandage is applied to cover the injection site.
• The procedure takes about 15-30 minutes unless additional level(s) are injected.

After the Procedure

• You are transported into the recovery area, where the medical staff continues to monitor your vital signs.
• You may be discharged home 30-60 minutes after the procedure with written instructions that may include:
  - Starting or resuming medication and activity.
  - Other restrictions on the day of the procedure.
  - Starting or resuming physical therapy and/or rehabilitation.
• The area around the injection site may feel numb. Tenderness around the site may be experienced for a couple of days after the injection.
• Keep a pain journal. It is important that you keep track of the amount of relief you obtain, as well as how long the pain relief lasts. This will help you and your doctor measure the effectiveness of the injection.
• Steroids may cause side effects, including blurred vision, frequent urination, increased thirst and change in blood sugar levels, especially in diabetic patients. If these side effects become bothersome or worsen, please call our office.
• If fever, chills, increased pain, weakness or loss of bowel/bladder function occurs, seek immediate medical attention.
• Please follow up with your doctor.