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Epidural

An epidural steroid injection (ESI) is a single spinal injection that delivers local anaesthetic and long acting steroid with an action over multiple levels in the spine. The steroids help to reduce the pain by reducing inflammation around the nerves.

These injections are predominantly used to treat pain radiating from the lower back into the legs or from the neck into the arms from conditions such as disc disease, nerve root compression and spondylolisthesis. An epidural can be combined with a nerve root injection which targets a specific nerve or group of nerves.

What happens?

Before the Procedure
  • An epidural injection is a day surgery procedure.
  • Do not eat for 6 hours before your injection.  You can drink water up to 2 hours prior to the procedure
  • Medication. Continue all regular medication on the day of the procedure except blood thinning medications such as warfarin or clopidrogrel which will need to be discussed with your pain specialist
  • Please ensure you have someone to drive you home, and stay for the first 24 hours
During the Procedure
  • The patient lies flat on his/her abdomen on an x-ray table
  • A local anaesthetic is administered to the injection site and some sedation is given
  • Using live x-ray for guidance, the consultant directs a needle toward the epidural space.
  • The needle is inserted into the base of your spine either in the back (lumbar epidural), neck (cervical epidural) or  just near your coccyx (caudal epidural).
  • Radio-opaque dye is injected to confirm that the needle is in the correct space.
  • The procedure usually takes 30 minutes with discharge from hospital after approx 2 hours
After the Procedure
  • You may experience short lived numbness and weakness in the legs.
  • Normal activities including work may typically be resumed the following day
Risks
  • Headache 1:200
  • The risks of permanent nerve injury are very rare
Effectiveness
  • The effects of the steroid can take up to a week to occur.
  • For those who do respond, its effect may last up to 6 months. This can be repeated up to 3 times per year.
  • Whilst the epidural injection is relatively safe and quick to perform, it has the disadvantage of being unpredictable in its action and short lived in its effect with some patients reporting no benefit.
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