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Epidural Injections

An epidural steroid injection is an injection of local anesthetic (numbing medicine) and steroid medication (Kenalog or depomedrol) into the epidural space. The epidural space is located in the spine just outside the membrane that covers the spinal cord and nerve roots. This membrane is called the dural membrane. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact with the bony structures of the spine.

The goal of an epidural steroid injection is to provide pain relief by reducing the inflammation (swelling) of the nerve roots as they exit the spine. This is done by injecting an anti-inflammatory medicine into the epidural space. An epidural steroid injection will not correct the pre-existing medical problem (i.e., spinal stenosis, herniated or bulging disc, arthritis, etc.), but it may improve the level of pain.

It is not unusual for a patient to require more than one injection to receive long term benefit. The injections are done in a series of three about 3-4 weeks apart, if needed. If the pain significantly improves, no further injection is needed unless the pain begins to come back.

What happens during the actual procedure?

After the doctor examines you and goes over the risks and benefits of the procedure, he or she will ask you to sign a consent form. Then, you will be assisted to the X-ray table and made as comfortable as possible lying on your stomach. Blood pressure and heart monitors will be put in place. You may have an intravenous (IV) catheter placed before the procedure, through which you may receive fluid and medication to make you more comfortable.

Your back or neck is then cleansed with alcohol and an antiseptic solution. A sterile drape is placed, and your skin is anesthetized (numbed) with a local anesthetic. You may feel a temporary stinging or burning sensation at this time. Under X-ray guidance, a small needle is then advanced into the epidural space. Pressure is the usual sensation felt during this procedure. If pain is felt, more local anesthetic will be used.

Once in the epidural space, X-ray dye will be injected to confirm the correct location of the needle, and the steroid mixture will then be injected, completing the procedure. (Please let the nurses and doctors know if you have ever had an allergic reaction to X-ray dye or shellfish!) After the injection, your skin will be washed and a band aid will be applied. Your blood pressure will be monitored in the recovery area for an appropriate time (usually 20-40 minutes) and you may be offered juice/soda and graham crackers. You will be given written and oral discharge instructions. You may go home with your driver after your doctor authorizes discharge.

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