Epidural Steroid

What is an Epidural Steroid Injection?

Epidural Steroid Injection is an injection of long acting steroids and local anesthetics in the epidural space - that is the area which surrounds the spinal cord and the nerves coming out of it.

What is the purpose of it?

The steroid injected reduces the inflammation and/or swelling of nerves in the epidural space. This may in turn reduce pain, tingling and numbness and other symptoms caused by nerve inflammation/irritation or swelling.

How long does the injection take?

The actual injection takes about 10 minutes.

What is actually injected?

The injection consists of a mixture of depo-medrol (steroid) and bupivacaine (local anesthetic).

Will the injection hurt?

The procedure involves inserting a needle through the skin and deeper tissues, so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the epidural needle. Most patients also receive intravenous sedation, which makes the procedure easy to tolerate. You may feel pressure in your back.

Will I be "put out" for this procedure?

Most patients receive intravenous sedation, which makes the procedure easy to tolerate. The amount of sedation given depends upon patient tolerance and medical conditions.

How is the injection performed?

The procedure is done by placing the patient on his/her side or sitting up. The patients are monitored with EKG, blood pressure cuff and blood oxygen monitoring device. The back is cleaned with antiseptic solution and then the injection is carried out. After the injection, the patient is placed on his/her back or side.

What should I expect after the injection?

Immediately after the injection, your legs may feel slightly heavy and numb. Also, you may notice that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. You may have a sore back for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief about three days after the injection.

What should I do after the procedure?

You will need a ride home. We advise patients to take it easy for the rest of the day after the injection. We do not recommend driving or walking without assistance for 24 hours after the injection.

Can I go back to work the next day?

You should be able to return to normal activities the next day.

How long will the effects of the medication last?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The steroid starts working in about three to five days and its effect can last for several days to a month.

How many injections do I need to have?

Usually after the first injection, you will be scheduled for another injection in a month, and then another in three months.

Can I have more than three injections?

Generally, we perform three to four injections in a year's time. Giving more could increase the likelihood of side effects from the steroids.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is temporary pain. The other risks involve spinal puncture with headaches, infection, bleeding inside the epidural space, nerve damage, worsening symptoms, etc. The other risks are related to the side effects of steroids, including weight gain, increase in blood sugar (mainly in people with diabetes), water retention, suppression of body's own natural production of cortisone, etc.

Who should not have this injection?

Who should not have this injection? If you are allergic to any of the medications to be injected, or if you have an active infection, you should not have the injection. If you are on Coumadin, you should notify the clinic at least five days prior to your appointment.