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Information for helping to manage pain.

Epidural Steroid Injections

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 pressure 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 of the nerve blocks.

Epidural Space:
Epidural space is the space outside the dura or covering the spinal cord. This space runs the length of the spine, and around the nerve roots.

Nerves travel through the epidural space to the arms and legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc, release of irritating 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 block places numbing and anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the arms and legs. It may provide long term pain relief, or pain relief for weeks or months.

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 to numb the site of injection. An epidural needle is then inserted into the epidural space of the cervical, thoracic, lumbar and caudal spine. 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.

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.

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.

Transforaminal Epidural Block
These are also called selective nerve root blocks or sleeve injections

How many types?

  • Cervical for neck
  • Thoracic for mid and upper back
  • Lumbar / sacral for low back
  • What is a nerve root?

Nerve roots exit the spinal cord and form nerves that travel into the arms or legs. These nerves allow movement of the arms, chest wall, and legs. These nerve roots may become inflamed and painful due to irritation, for example, from a damaged disc or a bony spur.

What is a transforaminal block?
Transforaminal or selective nerve root block provides important information to physicians, also a primary treatment in many cases. It serves to prove which nerve is causing pain by placing temporary numbing medicine over the nerve root of concern. If a patients usual pain improves after the injection, that nerve is most likely causing the pain. If the pain remains unchanged, that nerve is generally not the reason a patient may be experiencing pain.

By confirming the exact source of pain, it provides information allowing for proper treatment, which may include additional nerve blocks and/or surgery at a specific level.

What happens during the procedure?

  • The patient is placed on the x-ray table and positioned in such a way that the physician can best visualize the bony openings in the spine where the nerve roots exit the spine using x-ray guidance in the treatment room.
  • The skin on the spine is cleaned with alcohol.
  • Next, the physician numbs a small area of skin with numbing medicine.
  • After the numbing medicine has been given time to be effective, the physician directs a very small needle, using x-ray guidance near the specific nerve being tested. A small amount of contrast (dye) is injected to insure proper needle position. Then a small mixture of numbing medicine (anesthetic) and anti-inflammatory (steroid) is injected.

What happens after the procedure?
Immediately after the procedure, the patient will move around and try to imitate something that would normally bring about their usual pain. In the beginning of treatment phase, patient is monitored for relief and side effects.

The arm(s), chest wall or leg(s) may feel weak or numb for a few hours following the procedure. This is fairly common and happens following a selective nerve root block or transforaminal epidural injection.

Instructions

  • The patient 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.

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.

At Neuroscience Associates of Northern Kentucky we know you are seeking relief and expert Pain Management.  Our expertise will help start you on the road to recovery.  Schedule an appointment and let our doctors assess your unique condition and discuss treatment options that are right for you.