Epidural Steroid Injection (ESI)
What is an epidural injection of steroid?
An epidural is an injection of a small amount of local anesthetic and steroid into the epidural space outside the spinal cord area under x-ray guidance.
Why would an epidural be performed?
An epidural may be performed if you are experiencing pain in the neck, arms, chest, mid back, low back, and/or legs. An epidural may also be performed for pain following a diagnosis of shingles or for painful neuropathy.
What are the benefits of doing an epidural?
Epidural injections can reduce inflammation within and around the nerves and tissue, allowing for a reduction of pain, numbness, tingling, burning, sensitivity, and muscle cramping.
What are reasons NOT to do an epidural injection of steroid?
An epidural injection will NOT be performed if you have an active infection, fever, recent or pending surgery, bleeding problems, allergy to the local anesthetic and steroid, pregnancy, and/or if you are on blood thinner.
What are the preparations for the procedure?
Before the procedure, you are asked NOT to eat for four (4) hours prior and NOT to drink liquids two (2) hours prior to your procedure time. You must have a driver to drive you home following your procedure, as you will not be permitted to drive a vehicle on the day of your procedure. Anyone who is taking a blood thinning medication such as coumadin will be required to stop that medication for 3-5 days before the procedure, and Plavix should be stopped 7 days before the procedure. Otherwise, you may take your regularly prescribed medications the morning of your procedure with a sip of water. If you are a diabetic patient, you may eat a limited amount before your procedure to avoid hypoglycemia.
What are possible complications from the procedure?
This procedure does come with risks. Complications that can occur include but not limited to dural puncture, spinal headache, spinal cord trauma, infection, hematoma formation, epidural lipomatosis, pneumothorax, nerve damage, headache, death, brain damage, increased intracranial pressure, intravascular injection, vascular injury, cerebral vascular or pulmonary embolus, and reaction to the steroid medication.
What are possible side effects of steroid medication?
Administration of steroid medication can cause side effects. Side effects can include but not limited to hyperglycemia, altered menstrual cycle, fluid retention, bruising, insomnia, sweats, hot/cold flashes, flushing of the face, weight gain, epidural lipomatosis, steroid myopathy, avascular necrosis of bone, osteoporosis, and Cushing’s syndrome.
What will occur during the epidural procedure?
After the procedure and complications have been explained by the physician or physician assistant, an informed consent paper, (giving permission for the procedure), must be signed by the patient. Then, the patient is taken to the procedure room by a staff member. You will then lie down on the x-ray table on your stomach. The area to be injected will be cleaned using an antiseptic solution, which is usually betadine unless you are allergic to this. Numbing medicine will then be injected under the skin to numb the area where the injection will occur. The physician will then guide a needle into your epidural space under x-ray. The medicine will then be injected. Remember, the needle may not necessarily be placed in exactly the same area as your pain. When the medicine is injected, you may feel pressure sensation in your back and/or arms or legs that may be similar to your original pain. The medicine will be injected slowly to reduce your discomfort.
How long is the procedure?
Usually, the epidural lasts between 5-15 minutes depending on the area of injection. Keep in mind that the severity of the problem and other factors such as surgery and placement of hardware into the spine may make the procedure more challenging and may take longer to perform.
What happens after the procedure?
After the procedure is completed, the patient is taken to our recovery area. There, you will be monitored closely by checking the blood pressure, heart rate, and pain score level. You may be given something to drink at this time. Also, the staff will be observing for any signs of side effects from the procedure. When ready, you will be given discharge instructions and any follow-up information that is needed. Remember, you may experience numbness in the affected area until the local anesthetic wears off completely. It can take up to 72 hours before you feel the full effects of the epidural injection.
- If you suspect you might be pregnant or know you are pregnant, please notify the physician or any staff member, as this is a reason NOT to do the epidural injection of steroid.
- If you are a diabetic patient taking insulin or pills to manage your diabetes, the steroid used in the epidural can raise your blood sugar level temporarily. You should monitor your blood sugar level closely after your procedure.
- If your blood sugar level continues to be elevated then contact your primary care physician for suggestions on how to best manage this issue.
- After the procedure, you should resume your regular medications as you are prescribed if those medications were stopped before the injection.
- On the day of the procedure, you should not plan any strenuous activities. Usually, patients are able to resume their regular daily activities on the following day.
* If you do not understand any part of the above material, please discuss it with your physician or physician assistant. *