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Epidural Steroid Injection

What is an Epidural Steroid Injection?

An Epidural Steroid Injection is an injection of long lasting steroid into the epidural space which surrounds the spinal cord and the nerves coming out of it. The injection may be done into the neck, mid-back, or low back.

What is the purpose of the injection?

The steroid injected reduces the inflammation and/or swelling of nerves in the epidural space. It may not stop all pain but it may reduce pain and break the pain cycle or other symptoms caused by nerve inflammation/ irritation or swelling such as numbness and tingling.

What is injected?

 The injection consists of a mixture of a local anesthetic and steroid.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues. There is some discomfort involved. However, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle prior to inserting the Epidural needle. Also, the tissues in the midline have less nerve supply, so usually you feel strong pressure and not much pain. Most of the patients also receive intravenous sedation which makes the procedure easy to tolerate.

What are the risks and side effects?

With any procedure there are risks, side effects and possibility of complications. The most common side effect is pain, which is temporary. The other risks involve spinal puncture with headaches, infection, bleeding inside the epidural space with nerve damage, worsening of symptoms etc. The other risks are related to the side effects of cortisone: these include increase in blood sugar (in diabetics) and suppression of body’s own natural production of cortisone.

What should I expect after the injection?

Immediately after the injection, you may experience numbness, tingling, and/or weakness of affected extremities. You may have an increase in pain for the next 2-5 days then you should begin to see improvement. This pain is due to the process of the needle insertion as well as the initial irritation from the steroid itself. Use of ice to painful areas is encouraged.

Will I need more than one?

In some cases it may be necessary to repeat the procedure as many as three times to get the full benefit of the medication. However, many patients get significant relief from only one or two injections.

What should I do to prepare for the procedure?

To prepare for the procedure, do the following:
  1. Bring a list of your current medications, allergies and surgeries with dates if known.
  2. If you are on any type of blood thinning medications i.e. Coumadin, Heparin, Ticlid, Pletal, Plavix, Lovenox, Trental Aggrenox, Agrylin,  please notify your physician at least 2 weeks prior to your appointment.
  3. Notify the Pain Management Center if you are pregnant or have an infection.
  4. You must have a driver with you.
  5. You may take routine medications including pain medicine. Please do not take blood thinning medications.
  6. You must not eat or drink 6 hours prior to the procedure.
  7. Please wear loose fitting clothing (elastic waist is advisable).

What should I expect the day of the procedure?

  1. Your medical history will be reviewed.
  2. You will be monitored during and for a minimum of 30 minutes after the procedure.
  3. An IV will be started.
  4. You will not be able to return to work that day. You are advised to go home and rest until the following day. It is advisable to have someone with you at home for the remainder of the day.
  5. After the procedure you may eat. Normal medications except for the blood thinners may also be resumed.  You will be advised when to restart blood thinners.