Epidural Steroid Injections

Epidural Steroid Injections

What is an epidural steroid injection (ESI)? An ESI is the injection of a steroid medication mixed with saline into the epidural space in your spine (neck or back). The epidural space is located in the spine, just outside the sac containing your spinal fluid, and contains the nerve roots that can become irritated and inflamed from problems in your spine, causing you pain. The goal of an ESI is to provide pain relief by reducing the inflammation (swelling) of nerve roots (tissue) and to promote healing in the area. There is no way to predict if and how much relief you will obtain. An ESI will not correct the preexisting medical problem (e.g., herniated disc, spinal stenosis), but hopefully it will help decrease the amount of pain you are experiencing. Ideally, the end result will allow you to become more active again.

It is not unusual for someone to need more than one injection, two to four weeks apart, to get maximal, long-term relief. Typically, you are limited to three ESIs per 12-month period because the medication lasts long and subsequent doses are cumulative. Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.

What are the risks of the procedure? Risks / complications are rare but include bleeding, infection, nerve injury and allergic reaction to the medication. Diabetics may have a temporary increase in their blood sugar due to the steroid medication.

What happens before, during the procedure? After checking in and signing a consent form, you will be taken to a pre-op area where we will insert an intravenous line for sedative medication, and you will change into a hospital gown. You will then be taken to a special procedure room where nursing staff will position you on your abdomen. After you are sedated, the area of injection is then cleaned with an iodine solution and draped, and then the doctor numbs the skin and underlying tissue with a local anesthetic injection. A needle is then advanced into the epidural space, and dye may be injected at this point to confirm correct needle position. Please let the doctor know if you have any allergies to dye. The steroid/saline mixture will then be injected slowly. Your skin will then be cleaned and the procedure completed. Nine out of 10 patients report that it was less painful than they expected.

What happens after the procedure? The steroid usually takes 48 hours to take effect. Some people actually have a slight increase in their pain level temporarily. Local soreness from the needle is also expected. You may take your usual pain medications for this. Using an ice pack at the site of injection may help, as well. An adult must be present to drive you home and you are not to drive the remainder of the day. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of your procedure. Otherwise, you can do whatever you feel up to doing.

You should call us immediately at 409-892-4600 if you experience any of the following:

  • Severe neck / back pain that is not relieved with medication and ice
  • New numbness or weakness of the legs (or arms after cervical injection)
  • Loss of control of your bladder or bowels
  • Signs of infection in the area of injection (redness, drainage, elevated temperature).
  • Things to Do Before the Procedure

  • Arrange for an adult to drive you home. You are not to eat or drink anything 8 - 12 hours before the procedure.
  • Take all of your medications as scheduled on the day of the procedure, unless directed otherwise.
  • IF YOU ARE ON ANY BLOOD THINNERS (e.g., aspirin, Coumadin, Plavix, Pletal) or anti-inflammatories); most must be held for a period of time before the procedure, with written approval of the prescriber.
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