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Epidural Steroid Injection

What is the epidural space?

The epidural space is the area that surrounds the spinal cord and nerves coming out of it.    

What is an Epidural Steroid Injection? The epidural steroid injection (ESI) is an injection of local anesthetic and steroid medication in the epidural space. The injection is done to decrease the inflammation and/or swelling of nerves in the epidural space. This in turn may reduce pain, tingling and numbness, as well as other symptoms caused by the nerve inflammation/irritation or swelling. The local anesthetic or numbing medication will wear off approximately six hours after the injection. Your pain may briefly return before the steroid medication takes affect. This does not mean the block did not work. The steroid or anti-inflammatory medication may not start working for 24 to 72 hours. Sometimes it can take up to one week for the steroid to work or take affect. You may experience a sore back for a day or two after the procedure. This soreness may be the direct result of the needle being inserted into the epidural space and from the medication injected during the ESI. The ESI can last anywhere from days to months. If the first ESI does not relieve your pain and symptoms in 2 weeks, you may be scheduled for a second injection. Also, if the second injection does not relieve your symptoms in two weeks a third ESI can be done. 

How will the procedure(s) be performed? You will arrive at the George Isaac Center approximately 45 minutes before your scheduled procedure. The nurses will have you change into a hospital gown, complete the necessary medical forms, take your vital signs and start an IV. The IV will be used during the procedure to give you medication to relax you and control your discomfort. It is necessary that you remain awake during the procedure so that you can tell the physician if you have any unusual symptoms or discomfort. You will be transported by cart to a special room and positioned on your stomach on a special x-ray table. The skin on your back will be cleaned with antiseptic cleanser and then draped with sterile towels. Under fluoroscopy, a special X-ray machine, the doctor will determine the exact location for the ESI. The area where the needle will be inserted is injected with local anesthetic (numbing medication similar to what your dentist uses). The needle is then inserted under fluoroscopy, which allows the doctor to see your spine and the needle as it moves into the epidural space. Once the needle is in the correct position the medication is injected. Your skin will be cleansed and a band-aid dressing applied. You may remove the band-aid the following day. You will then be transferred by cart back to the recovery area where you will be monitored closely for the next 30-45 minutes. You will be given specific written discharge instructions and allowed to leave by wheelchair with your ride once the physician authorized your discharge.

What are the complications of these procedures?

There is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Short term side effects may occur. These can be the spread of local anesthetic to nearby nerves, which may result in weakness or numbness that can last for several hours. You may experience increased pain for several days after the injection, including localized pain at the injection site. If you are diabetic, your blood sugars may be elevated short term. Individuals that are prone to fluid retention may have increased fluid retention for 1-2 weeks.  

What should I do after the procedure?  

You will be given a discharge instruction sheet prior to leaving the recovery area. This sheet provides you with detailed information regarding complications, side effects, restrictions and when to contact the Pain Medicine Center or seek immediate treatment at the Emergency Room. A follow up appointment will also be scheduled for you prior to discharge from the Recovery Room.    

There are NO GUARANTEES that this injection, or any other type of treatment, will relieve your pain.

Last Updated: 10/17/13