Before receiving an epidural injection, you will probably undergo an imaging test. This may involve a CT scan or an MRI of the back. The test allows the doctor to identify possible causes of back pain.
Epidural and spinal blocks are types of anesthesia in which a local anesthetic is injected near the spinal cord and nerve roots to block sensations of pain from an entire region of the body, such as the abdomen, the hips, the legs, or the pelvis. Epidural anesthesia involves the insertion of a hollow needle and a small, flexible catheter into the space between the spinal column and outer membrane of the spinal cord (epidural space) in the middle or lower back.
At the doctor’s office, you will lie face down on a table or special bed. The doctor might give you a sedating medication. But sedation is not usually necessary. The epidural injection takes place in several steps:

  • The skin will be cleaned and injected with an anesthetic to numb it.
  • The doctor will insert a needle through the skin toward the spine.
  • The doctor will use a machine that produces live X-ray video called fluoroscopy. With it, the doctor will maneuver the needle between the bones of the spine.
  • Using a contrast dye, the doctor will confirm the needle is placed in the epidural space. That’s the space between the spine and the spinal cord inside it.
  • When the needle is in position, the doctor will inject a solution into the epidural space. The solution contains a steroid medicine, also called corticosteroid, and usually an anesthetic medicine too.
The long acting steroid injected reduces the inflammation and swelling of spinal nerves and other surrounding tissues in the epidural space. This may in turn reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling.
Epidural injections are most commonly performed for nerve root pain into the arms or legs caused by some irritating or inflammatory process such as a disc herniation. The success rate may be as high as 70 percent or more for patients with these symptoms. Epidural injections are also quite successful for spinal stenosis or a gradually tightening of the spinal canal from degenerative processes. Epidural injections can also help degenerative disc disease, certain neuropathies, reflex sympathetic dystrophy and other conditions. In most cases, patients who have epidural injections have already tried other, more conservative, treatment such as anti-inflammatory medication, chiropractic or physical therapy.

The actual injection takes five to 10 minutes.
The injection consists of a mixture of saline, a very small amount of local anesthetic and a long acting steroid medication.

The procedure involves inserting a needle through skin and deeper tissues. There is some pain involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the epidural needle. Also, the tissues in the midline have less nerve supply, so usually you feel more of a strong pressure and not as much sharp pain. Some patients choose to receive intravenous sedation that can make the procedure easier to tolerate.

This procedure is done under local anesthesia. Some patients choose to receive intravenous sedation that can make the procedure easier to tolerate. The amount of sedation given generally depends upon the patient.
Most patients receiving sedation are monitored with EKG, blood pressure cuff and oxygen monitoring device. Patients not receiving sedation are monitored if needed. The skin of the neck or back is cleaned with antiseptic solution and then the injection is carried out. Most, if not all, neck injections are done under x-ray lying on the side. Mid and lower back injections, may or may not be done under x-ray and can be done either sitting or lying on the stomach or the side.

Immediately after the injection, you should feel much the same as before the injection. You may have a small numb area at the injection site. You may also experience some aching from the passing of the injection needle. Certain patients, especially those with prior neck or back surgery around the injection site, may have some soreness or aching for a day or two. This is due to the mechanical process of needle insertion, as well as initial irritation from the volume of the medications injected. You should start noticing pain relief within the first 24-72 hours.

Any patient receiving sedation must have a ride home. Patients not receiving sedation are usually able to drive. Most patients are advised to take it easy for a day or so after the procedure until the medication has a chance to work. However, most patients can perform any activity that they could perform before the procedure.

Most patients return to work the next day. You may feel some soreness or aching at the injection site only, however the pain would be minimal and pass within 24 hours.
The long acting steroid is generally effective within 2 to 5 days, and its effect can last for several days to a few months.
Not exactly. The epidural injection is certainly injected into the same space. However, for women in labor, a much larger introducer needle is used so that a catheter can be threaded into the epidural space. Then an injection and infusion of numbing medicine or local anesthetic is used to decrease the sensation of labor pain. This amount of numbing may make it difficult to walk or even move the legs. Epidural injections, on the other hand, rely primarily on the effect of a long acting steroid to relieve pain by decreasing inflammation and swelling. Very little local anesthetic is used so that there is no weakness or numbness of the arms or legs after the epidural injection.

Physicians have been using epidural steroid injections for back pain for more than 60 years. It is a safe procedure when a qualified physician performs it in a sterile setting, using the drugs appropriately and only after a proper diagnosis.
The network specialist and physician will give specific instructions prior to the procedure. Generally, patients come in about one hour prior to the procedure. Some patients require blood work to rule out an infection or bleeding risks. Patients usually can eat a light meal 4 - 6 hours prior to the procedure, and they can resume their normal eating habits after the procedure.

You can ask the doctor at the time of your appointment or give us a call at 855-292-PAIN.