Epidural injections

An epidural injection aims to inject medications into the space surrounding the spinal cord within the bony spine. Caudal epidural is done through the space above tailbone for same purpose.

This procedure is done as a day case procedure. X-ray is used to direct the needle in to the space. You need to lie on your front for approximately 15-20 minutes. Local anaesthetic is given to skin before the actual spinal needle is inserted. Once the correct position is found (with help of contrast dye under X-ray), the joint is injected with local anaesthetic and steroid.

Instructions to patients: You should be starving for six hours before the procedure, but can take clear water upto 2 hours before. Take all your medicines unless instructed otherwise. Once you come to hospital, a nurse will check all details and note it. The pain doctor will explain procedure and get a consent form signed. You should be prepared to stay in hospital atleast till lunch time (may be longer occasionally). You cannot drive or lift anything heavy or hot till midnight. Please arrange for someone to collect you after procedure.

Side-effects: More discomfort for first few days after injection (flare-up pain); fall in blood pressure(immediately after procedure, which can be treated with intravenous fluids); infection (rare); bruising at site of injection; weakness of legs due to local anaesthetic (lasts for few hours); headache (0.5 to 1% incidence); risk of nerve damage (1 in 10,000 and can last long); steroid effects (puffiness face, blood sugar changes if diabetic).

Post-procedure instructions: You need to maintain a pain diary after procedure, which will help doctor plan further interventions in future. Take it easy till next day; continue taking your pain killers till you notice any improvement.

Faculty of Pain Medicine guidance leaflet available at Epidural injection.