Pain can be produced from the ligaments, discs and nerve rootlets within the epidural space. Bathing all these structures in a large volume of local anaesthetic and cortisone is capable of producing weeks or months of relief from such pain. Even if the duration of relief is much shorter than this, it can help with making a diagnosis of the source of your back pain. Prior to your theatre appointment, you will have to fast the hospital will advise you the day prior for fasting requirements.
You lie on the operating theatre table while x-rays are taken to establish where the needle should go. After a sterile preparation, local anaesthetic is used to numb the skin and superficial tissues. The needle is passed through the anaesthetised tissue into Caudal hiatus under x-ray guidance. When the needle looks to be in the right position, adequate placement is confirmed by injecting a little contrast dye.
Once the needle is confirmed to be in the epidural space, diluted local anaesthetic and high-strength cortisone is put down the needle, to a total volume of 10ml. Please note that you will not be able to drive for 24 hours after your procedure. You will be observed in the recovery room for minutes and will be free to leave the hospital soon after that.
What is the epidural space and what is an epidural injection? The covering over the nerve roots in the spine is called the dura. The sleeve-like space surrounding the dura is called the epidural space. Nerves travel through the epidural space before they travel into your legs. The nerves leave the spine from small nerve holes.
These nerves may become inflamed due to irritation from a damaged disc or from contact with a bone spur. Inflammation of these nerves may cause pain in your low back, hip, buttock and legs. An epidural injection places anti-inflammatory medicine cortisone into the epidural space to reduce nerve inflammation, and hopefully reduce your symptoms.
By stopping or limiting nerve inflammation we may promote healing and reduce pain. Although not always helpful, epidural injections reduce pain and improve symptoms in most people within 3 to 7 days. They may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective.
Your doctor may order up to three epidural injections spaced approximately 2 to 4 weeks apart. Performing a repeat injection depends on your response to the prior injection. If you obtain excellent relief from an epidural, you do not need to have it repeated. What will happen to me during the procedure? First, an IV is started so that you may be given medicine for relaxation if you so desire.
Next, while lying face down on a x-ray table your skin will be well cleansed with an antiseptic. The physician will numb a small area of skin where the epidural needle will be inserted. The injection will occur at the top of the buttock crease where there is a small opening to the epidural space. Next, the physician will use x-ray guidance to direct a small needle into the epidural space.
There will be pressure felt with this part of the procedure. He will then inject contrast dye to confirm that the medicine spreads to the affected nerve s in the epidural space. After this, the physician will inject a combination of numbing medicine anesthetic and time released anti-inflammatory cortisone. What should I do and expect after the procedure?
This may last several hours but you will be able to function safely as long as you take precautions. You will report your remaining pain if any and also record the relief you experience over the next week in a pain diary, which we will provide. You may notice an increase in your pain lasting for several days.
This occurs after the numbing medicine wears off but before the cortisone has a chance to work. Ice will typically be more helpful than heat during this time. You may begin to notice an improvement in your pain 3 to 5 days after the injection. Improvements will generally occur within 10 days after the injection. On the day of the injection, you should not drive, and should rest and avoid any strenuous activities.
You may take your regular medications at their usual times after the procedure including your pain medicine if needed. On the day after the procedure, you may return to your regular activities. When your pain was improved, start your regular exercise in moderation. Even if you are significantly improved, gradually increase your activities over 1 to 2 weeks to avoid recurrence of your pain.
Epidural Injections can be a very helpful adjunct in rehabilitation of patient's the spine pain that radiates into an arm or leg or in the thoracic spine around the chest or trunk. They work by placing cortisone a potent anti-inflammatory medication close to an inflamed nerve.
This allows the patient to be fully able to regain full motion and increase the muscular support of the spine critical in the recovery and prevention of future episodes. They are generally not indicated in spine pain that does NOT radiate from an irritated spinal nerve.
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