Epidural Steroid Injections

What is an Epidural Steriod Injection and how does it help me cope with my pain?

What is an Epidural Steroid Injection? (ESI)

Epidural Steroid Injection is an injection of long lasting steroid  (cortisone) into the epidural space, which is the area that surrounds the spinal cord and the nerves coming out of it.

How does it work?

The steroid reduces the inflammation and swelling of nerves in the epidural space.  This will then reduce the pain, tingling and numbness and other symptoms caused by the nerve inflammation.

How long does the injection take?

The actual injection takes only a few minutes.

What medications are used for the injections?

The injection consists of a mixture of local anesthetic (lidocaine or bupivicaine) and the steroids (depo-medrol or betamethasone)

Does the injection hurt?

The procedure involves inserting a needle through the skin and deep tissue.  So, there is some discomfort involved.  But, we will numb the skin and deep tissues with a local anesthetic (lidocaine) before inserting the block needle.  Most of the patients also receive intravenous sedation and pain medication, which makes the procedure easier to tolerate.

Will I be “put to sleep” for this procedure?

No.  This procedure is done under local anesthesia.  Most of the patients also receive intravenous sedation and pain medication, which makes the procedure easier to tolerate.  The amount of sedation given usually depends upon the patient tolerance.

How is the injection done?

It is done with the patient lying on their stomach, under fluoroscopy (live x-ray).  All of our patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device (pulse oximeter).  The skin on your back is cleaned with antiseptic solution and then the injection is done.

What should I expect after the injection?

Response may vary among patients.  Relief from the injection generally takes about three days.  Although some feel immediate relief, others do not until 3-5 days after the injection.  Not all patients receive significant relief of their pain from the epidural injection.  A small percentage of patients have increased pain from the injection. This may be from the needle placement.  This usually lasts for 1-2 days.  Treat with ice or heat.  Take medications as prescribed.

What should I do after the procedure?

You need to have a ride home if you have had any sedation.  Make sure that you have something to eat or drink after the block.  We advise the patients to take it easy for a day or so after the procedure.  You may want to apply ice to the affected area.  Perform your normal daily activities as tolerated.

When can I go back to work?

Unless there are complications, you should be able to go back to work the next day.  The most common thing you may feel is a sore back or neck depending on the injection site.

Ice at the injection site will help with the soreness. You may also take ibuprofen or acetaminophen for the discomfort.

How long will the block work?

The immediate effect is usually form the local anesthetic injected.  This wears off in a few hours.   The cortisone starts working in about 3 to 7 days and its effects can last for several days to a few months.  Success rates vary on the primary diagnosis and whether or not the injections are being done only for diagnosis.

How many injections will I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have a repeat injection.  If you respond to the injection and still have residual pain, you may be recommended for a third injection.  Repeat injections are commonly recommended by the PCP or the anesthesiologist.

Can I have more than three injections?

In a six-month period, we usually do not perform more than three injections.  If three injections have not helped you much, it is unlikely that you will get any benefit from more injections.  Also, giving more injections will increase the likelihood of side effects from cortisone.

Does the Intralaminar ESI help everyone?

No.  It is difficult to predict if the injection will help or not.  Usually, the patients who have recent onset of pain tend to do better than those with long standing pain. Patients who have “radicular symptoms” like sciatica respond better than the patients who have only back pain.  Patients with back pain mainly due to bony abnormalities may not respond adequately.

What are the risks and side effects?

The procedure is safe.  But, with any procedure there are risks, side effects and possibility of complications.  The most common side effect is pain- which is temporary.  The other risk involves spinal puncture with headaches, infection, bleeding inside the epidural space with nerve damage or worsening of symptoms.  The other risks are related to the side effects of cortisone these include: weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body’s own natural production of cortisone etc. Fortunately, the serious side effects and complications are rare.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (i.e. Coumadin, Plavix,) aspirin or aspirin containing medication, or if you have an active infection you should not have the injection.  Be aware that herbs Ginseng, Garlic and Gingko Baloba and Vitamin E are blood thinning.

 

*DO NOT STOP ANY OF YOUR MEDICATIONS BEFORE CONSULTING WITH YOUR DOCTOR*