Epidurals
Epidurals are one of the most well known types of injections for back & lower body pain and are particularly useful for pain caused by damaged nerves or inflammation.
How does an epidural work?
An epidural steroid injection (ESI) works slightly differently and is used for chronic pain management. Instead of anesthetic medication, your provider injects a steroid or corticosteroid medication into the epidural space around your spine. Instead of blocking pain or feeling in a region of your body, the steroid coats the irritated nerve(s) that are causing you pain and works to reduce swelling. The steroid allows the nerve(s) time to heal. Epidural steroid injections can lead to temporary, long-term or permanent pain relief.
Who performs an Epidural?
Healthcare providers of other specialties, such as neurology.
How to prepare for an epidural?
Your healthcare provider will give you specific instructions about what you need to do to prepare for your epidural. Be sure to follow their instructions. Your provider may:
Have you not eaten or drink for a certain amount of time before your epidural.
Adjust certain medications you’re taking, especially blood thinner medications.
Make sure you have someone with you to drive you home after your epidural.
What happens during the epidural procedure?
Single-injection epidurals are similar in procedure to epidurals that use a catheter except there’s no catheter placement. Your provider will inject one dose of medication when they insert the needle into your epidural space.
You will lie on a comfortable table on your stomach or side.
Your healthcare provider will thoroughly clean the area of your back where they’ll insert the epidural to minimize the risk of infection.
Your provider will inject local anesthesia with a small needle near the area where they’ll insert the epidural. This is so you won’t feel as much pain when they insert the epidural needle, which is larger than a standard shot needle.
Once the area is numb, your provider will most likely use an imaging machine, such as fluoroscopy equipment or a CT scanner (both are radiology imaging) to help guide the epidural needle to exactly the right position.
When the epidural needle is in place in the epidural space around your spinal cord, your provider will inject the contrast material. The contrast material will make it easier for your provider to see the area they’re targeting on the screen of the imaging machine. This helps to make sure that the medication will reach the inflamed nerves they are targeting.
Your provider will then slowly inject the medication, which is usually an anti-inflammatory medication, such as a steroid or corticosteroid. Some providers may inject a mixture of a corticosteroid and a long-acting anesthetic.
When your provider is done with the injection they’ll clean the area again and apply a dressing to the site. You’ll move into a chair or bed to rest for a few minutes to an hour. This is so your provider can make sure you don’t have any reactions to the medication before you go home.
What happens after epidural procedure?
Epidural steroid injections start working within two to seven days, and the pain relief can last several days or longer.