Epidural injections offer temporary pain relief for patients who have inflammation in the spine or extremities. Imaging assists with finding the exact location of pain and where the needle should be placed for a stronger, more lasting effect.
What Is an Epidural Injection?
The procedure involves injecting medication, such as a steroid, anesthetic or anti-inflammatory, into the epidural space, located toward the outermost section of the spinal canal. After the injection, the patient typically experiences less pain and decreased swelling around any damaged or healing nerve roots.
To pinpoint the exact spot for injection, fluoroscopy involving X-rays or a computed tomography (CT) scan may be used. During this portion of the procedure, the patient lies on a radiographic table, while one or two X-ray tubes and an X-ray detector take images of the affected area.
Fluoroscopy translates the X-rays into video images, displayed on a monitor in an adjacent room where a radiologist or technician communicates with you via speaker or microphone. If CT technology is used, the table passes through a round machine with a tunnel going through the middle. Positioned on a gantry, the X-ray tube and detectors travel around you to take the images.
After imaging determines the ideal spot of injection, a syringe with medication is administered at the precise site.
The resulting pain and inflammation relief can make performing daily tasks easier for patients. Imaging also helps to identify the source of the pain, after other methods have been exhausted or produced inconclusive results, while lessening the need for more invasive procedures.
As the injection is frequently done around the spine, certain risks include:
- A temporary increase in pain
- Hot flashes, a rash or other reaction to the injected medication
- Infection or bleeding
- Nerve injury
- Temporary paralysis, possibly leading to bladder or bowel dysfunction
- Low-level radiation exposure
- Spinal cord injury
Who Should Have This Procedure?
A doctor may recommend an epidural injection if the patient has tried more standard treatments without success. This procedure may be ideal for the following conditions:
- Herniated or bulging discs that affect the nerves
- Spinal stenosis
- Chronic back or leg pain following a surgical procedure
- Injuries to the spinal nerves, vertebrae and surrounding tissue
- Bone tissue
However, not all epidural injections are the same. They often depend on the medication being used and where the injection is performed. As such, some patients may feel its effects for longer or could only experience temporary relief.
In an ideal scenario, the injection causes the medication to progress through the epidural space, coating and soothing the inflamed nerve roots. A patient may have a corticosteroid injected:
- In the lumbar or lower back region to directly alleviate pain or have it travel to the lower extremities.
- In the neck to directly pain or to have it travel into the arms.
In many cases, patients undergo multiple epidural injections before experiencing significant relief. However, after some point, the pain may start to return. If the series of injections doesn’t have a long-lasting effect, your doctor may seek a different approach.
Due to the potential risks, epidural injections are not recommended for pregnant women, as the developing fetus may be exposed to radiation during the imaging portion.
Prior to the procedure, your doctor may provide steps to prepare, including any changes to your medication schedule. Patients are further instructed not to eat for several hours before, as the sedation may cause an upset stomach. Additionally, inform your doctor if you are or think you may be pregnant, and prepare to have someone available to drive you home following the injection.
On the day of the procedure, arrive in loose-fitting clothing and keep all jewelry and metal items at home. You may also be asked to wear a gown and to use the restroom before the imaging begins.
Typically, an epidural injection is done on an outpatient basis, although some patients may require admission. Although the injection lasts just a few minutes, imaging often takes longer.
As the procedure begins, you will be positioned on your stomach or side for efficient, direct access to the injection site. From here:
- You may have an IV inserted into your arm, which will deliver a sedative or another relaxing medication.
- Once imaging helps identify the injection site, the skin will be cleaned and sterilized with an antiseptic. Local anesthetic may also be used to numb the area.
- Imaging may then be employed to guide the epidural needle to the exact position. At this stage, contrast material may be injected, so the doctor can clearly see the nerves before injecting the medication. Typically, a patient is given an anesthetic and anti-inflammatory medication.
- Following the injection, patients rest on a chair or bed to see if they react well to the medication. You may need to wait a few minutes to an hour.
- The epidural often has an immediate effect, with patients noticing improvement over the next 48 hours. For patients who experience numbness at this stage, they may require assistance walking or getting into their car. This feeling disappears soon after and patients can resume their everyday activities within a day or so.
Following an epidural injection, your doctor will schedule a follow-up visit to discuss any symptoms, side effects and determine if any subsequent injections, imaging or blood work are needed.
Has your doctor recommended an epidural injection? Contact us to make an appointment today!