The Pain Management Center : Epidural Injections

Epidural Injections

INTRODUCTION Common causes of pinched nerves include disc protrusions into the nerve space, arthritic facet joints with resultant narrowing of the spinal canal, and bone spurs. Less often, scar tissue that has formed from a previous surgery can cause nerve impingement and pain.

Nerves exit the spinal cord through the epidural space. Often, this space is utilized to deliver medicine in close proximity to the spinal nerves. The most effective medications include local anesthetics (numbing medicines) and anti-inflammatory steroids, which help reduce swelling and inflammation that can lead to pinched nerves.

EPIDURAL SPACE

Epidural Space is the space outside the dura or covering of the spinal cord. This space runs the length of the spine.

The spinal cord and nerve roots in the spine are covered by a membrane called the dura. This is called the epidural space.

Nerves travel through the epidural space to the neck and arms or the back and into legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc, release of irritation substances or from contact in some way with the bony structure of the spine.

What is an epidural and what does it do?

An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs.

The epidural injection may help the injury to heal by reducing inflammation. It may occasionally provide permanent relief, but pain relief for several days, weeks or months while the injury/cause of pain is healing.

How many types?

They are called:

Cervical epidural in the neck
Thoracic epidural in the mid and upper back
Lumbar/caudal epidural in the low back
Cervical transforaminal in neck
Thoracic transforaminal in mid and upper back
Lumbo-sacral transforaminal in low back

How is it done?

A local anesthetic is given. An epidural or spinal needle is then inserted into the epidural space of the cervical, thoracic, lumbar and caudal spine or cervical, thoracic or lumbosacral nerve roots. An anesthetic and steroid are injected into the epidural space.

Expected Results?

Relief of pain as the medication reaches the inflamed area or source of pain.

How long does it take?

Thirty minutes plus approximately forty-five minutes of recovery time.

The Classic (usual or old fashioned) Epidural Injection

The epidural space is often accessed using a special type of injection. First, a sterile solution is applied to the target site. Next the site is numbed with a small injection of a local anesthetic. A special type of needle is used to identify the epidural space.

Specialists in pain management can offer techniques to overcome the deficiencies of this technique. Unfortunately, many patients do not experience complete relief of their pain. When complete pain relief is not achieved, the pain management specialist may carefully question the patient, utilize directed exam techniques, and radiographic studies to help guide more specific injections.

Epidural Injection with X-ray Guidance

A technique utilizing fluoroscopy is often used to guide the needle. The practitioner is able to watch the needle as it moves through tissues to its destination. Fluoroscopy makes it possible to place the medicine close to the exact lesion location (pinched nerve). In addition, modifications, such as a flexible guided catheter can be maneuvered into the proper position to deliver medication. Other modifications include injecting into the foramen, the spinal windows where the nerves exit.

What happens during the procedure?

An IV is started so that relaxation medication can be given. You are placed lying on your stomach on the x-ray table and positioned in such a way that the physician can best visualize the low back using x-ray guidance in the operating room. The skin on the spine is scrubbed with a sterile solution.

Next, the physician numbs a small area of skin on the low back with numbing medicine.

After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure proper needle position in the epidural space. A mixture of numbing medicine (anesthetic), and anti-inflammatory (steroid) is injected.

Caudal Epidural (injection above tail bone)

Interlaminar or old fashioned epidurals

What happens after the procedure?

You are returned to the recovery area where you are monitored for 15-30 minutes. A follow-up appointment will be made. The legs may feel weak or numb for a few hours. This is to be expected, however it does not always happen.

Instructions

Patients can eat a light meal within a few hours before the procedure.

If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure.

Patients may take their routine medications. (i.e. high blood pressure and diabetic medications).

Post-procedure Instructions

You were given a number of medications during the procedure. These sometimes include sedatives, narcotics, local anesthetics, steroids, and other medications. Any of these drugs or procedure itself, sometimes can cause side effects, including drowsiness, temporary numbness, weakness and soreness.

What To Do After the Procedure?	Rest for a few hours and use assistance if needed. Resume activity as tolerated, but do not overdo. Resume regular diet.
Restrictions:	Do not drive or operate machinery for at least 12 hours. Do not make important decisions for 12-24 hours after treatment. Walk with assistance as long as numbness, weakness, or drowsiness is present.
Notify If You Have:	Excessive or abnormal bleeding / persistent chills or fever over 100°F If there is a major change in pain pattern or level.
Emergency:	In case of emergency, call (270) 554-8373. If unable to reach the physician, report to the nearest emergency room and request them to inform the physician at Pain Management Center.
Few Other Things:	Take your usual medication. Apply ice massage as instructed; may use heat if ice is intolerable. If IV site becomes painful, place warm towels on the site for 20 minutes 2-3 times / day.