Epidural Steroid Injection/Trans-Interlaminar or Trans-Foraminal
What is an Epidural Steroid Injection?
Epidural Steroid Injection is an injection of long lasting steroid in the Epidural space – that is the area which surrounds the spinal cord and the nerves coming out of it.
What is the purpose of it?
The steroid injected reduces the inflammation and/or swelling of nerves in the Epidural space. This may in turn reduce pain, tingling and numbness and other symptoms caused by nerve inflammation/irritation or swelling.
How long does the injection take?
The actual injection takes only a few minutes. You will be asked to take a seat after the procedure for about ten to 15 minutes before leaving the office.
What is actually injected?
The injection consists of a mixture of local anesthetic (like Lidocaine or Bupivacaine) and the steroid medication—Depo-medrol®).
Does the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "tetanus shot"). So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the Epidural needle. Also, the tissues in the midline have less nerve supply, so usually you feel strong pressure and not much pain.
Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia. Some patient’s who experience anxiety will be instructed to take a sedative 30 minutes prior to the procedure which makes the procedure easy to tolerate.
Patients taking a sedative must have a ride to and from our pain center.
How is the injection performed?
It is done on your stomach. The patients are monitored with a blood pressure cuff and blood oxygen monitoring device. The skin on the back or neck is cleaned with antiseptic solution and then the injection is carried out. After the injection, you will come slowly to a sitting position and the doctor will show you the pictures of your spine taken during the procedure.
What should I expect after the injection?
Immediately after the injection, you may feel your legs slightly heavy and may be numb. Also, you may notice that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last for a few minutes or up to a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the third day or so. You may apply ice to the injection site for additional relief.
What should I do after the procedure?
We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you.
Can I go back to work the next day?
You should be able to unless the procedure was complicated. Usually you will feel some back pain or have a "sore back" only. No heavy lifting or bending is recommended the day of the procedure.
How long the effect of the medication lasts?
The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about three to five days and its effect can last for several weeks to a few months.
How many injections do I need to have?
If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. Similarly, if the second injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have a third injection.
Can I have this procedure while on blood thinning medications?
No, patient’s taking Coumadin and Plavix must obtain permission from the dispensing physician prior to stopping medications. Coumadin should be stopped five days prior to scheduled procedure and plavix should be stopped seven days in advance of procedure.