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 speed up mother nature, thereby reducing your pain. Epidural injections reduce pain and improve symptoms in most people within 24-48 hours. They may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective. Dr. Dominguez may choose to use a numbing medication with the cortisone. However, the numbing medication on these patients lasts 8-12 hours.
Dr. Dominguez may order up to three epidural injections spaced approximately 2-4 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. If you have partial sustained benefit (>30% relief) the epidural can be repeated for possible additive benefit. If an epidural injection provides minimal benefit (<30 % relief, Dr. Dominguez may choose another injection be performed with a change in technique and/or cortisone used; (Placebo is 10-20%).
What are the risks of the procedure?
As with most procedures, there is a remote risk of bleeding, infection, headache, nerve injury or allergic reaction to the medications used. Overall, epidural injections are safe. Additional short-term effects may occur. You may have some temporary numbness or weakness in your legs caused by the local anesthetic (numbing medicine). If this interferes with your ability to walk safely, you will have to be observed until it resolves. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars as a result of the steroid medication. As always, the patient and the physician will need to determine the benefit-risk ratio of any procedure.
Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. Please make Dr. Dominguez aware of any of these conditions. In addition you may not receive anesthesia if you fail to follow the preoperative instructions with respect to eating. These instructions are for your safety!
How do I prepare for my procedure?
No solid food or fluids after midnight prior to the procedure unless directed otherwise. On the morning of the procedure, you may take your non-pain medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before coming in. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, Aspirin or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication. Please make Dr. Dominguez aware that you are taking a blood thinner, and contact your primary care physician or prescribing physician before stopping this medication.
What will happen to me during the procedure?
You will be placed face down on an x-ray table and skin will be well cleansed with an antiseptic. Dr. Dominguez will numb a small area of skin with a cold spray and medication where the epidural needle will be inserted. You may feel an ultra-short episode of a mild stinging/burning sensation. The injection will occur at the top of the buttock crease where there is a small opening to the epidural space. Next, Dr. Dominguez will use x-ray (fluoroscopy) guidance to direct a small needle into the epidural space. There will be pressure felt with this part of the procedure. He may inject contrast dye to confirm that the medicine spreads to the affected nerve(s) in the epidural space. After this, Dr. Dominguez will inject the approach combination of numbing medicine (anesthetic) and time released anti-inflammatory (cortisone) through the needle or catheter. For those who receive IV anesthesia should not eat solid foods 6-8 hours prior to the procedure. Non-pain medication may be taken with a sip of water.
What should I do and expect after the procedure?
You may have some partial numbness in your buttocks and/or legs from the anesthetic after the injection. This may last several hours but you will be able to function safely as long as you take precautions.
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 1-3 days after the injection. Improvements will generally occur within 7 days after the injection.
Those who receive numbing medication and cortisone should not drive nor return to work. You should rest and avoid any strenuous activities. You may resume normal diet and medications after the procedure unless told otherwise by Dr. Dominguez. On the day after the procedure, you may return to your regular activities. When your pain improves, start your regular exercise in moderation. Even if you are significantly improved, gradually increase your activities over 1-2 weeks to avoid recurrence of your pain.
When Should I Call American Pain Institute?
We would like to speak to you the day after your procedure regarding your response. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain level, and if you are experiencing any problems. If you experience severe pain, new numbness or weakness of your legs, a temperature of 100.5 or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call our office immediately.