An epidural is commonly known as a nerve block to decrease pain and inflammation. Steroids are a powerful anti-inflammatory agent that may shrink swelling around nerve roots from an inflamed, bulging or herniated disc. Because of the low risk and incidence of significant complication, it is generally felt to be a reasonable procedure to follow when disc or nerve root pain which has failed to respond to more conservative measures. A large percentage of patients will get complete resolution of symptoms.
How is it done?
Initially a local skin anesthetic is given before a spinal needle is inserted into the epidural space of the lumbar or caudal spine. After verifying proper location, local anesthetic and steroids are delivered into the epidural space.
How often should I have this procedure?
It is generally an accepted practice that this procedure can be repeated up to three times within a few months, although in some cases, additional injections may be administered. Injections may be given as a single dose, or once every ten to fourteen days for a series of three. Additional injections seem to have additive effects.
What are the expected results?
Immediate, but temporary (few hours) pain relief may occur if the local anesthetic reaches the source of pain. The steroid benefit will typically not occur for several days to two weeks. If local anesthetic is used, patients are advised to avoid driving for 12 hours. By the next day, previous activities can be resumed. Despite the temporary improvement, patients are cautioned against strenuous activity. It is generally advised to pursue a course of gradual increase in activity, often coordinated with physical therapy or other training once the injections have been completed.
What are the risks or side effects?
Side effects and adverse reactions are rare. Steroids have been known to cause: fluid retention, weight gain, increased blood sugar (mainly in diabetics,) elevated blood pressure, mood swings, irritability, insomnia, and suppression of body’s own natural production of cortisone. Fortunately, the serious side effects and complications are uncommon. Additional risks associated with needle placement include dural puncture which may result in a severe “spinal headache”. Bed rest and increasing fluids/caffeine intake frequently alleviate symptoms. In rare cases it may be necessary to perform a “blood patch” to seal the leaking dura. Other rare potential risks include: worsening of pain symptoms, bleeding, infection, backache, bowel or bladder dysfunction, hematoma, cord compression, paralysis, neurologic damage or impairment, seizure or death. In order to avoid these complications, the procedure is done under strict sterile conditions, utilizing fluoroscopy to localize the epidural space and guide the needle.
How long does it take?
Thirty minutes plus approximately forty-five minutes of observed recovery time.