Epidural Cortisone Injections

Introduction

Epidural steroid injections (ESI) are commonly used to control back and leg pain from many different causes. These injections control pain by reducing inflammation and swelling. They do not cure any of the diseases they are commonly used for, but can control the symptoms for prolonged periods of time. In some cases, the ESI may be used to control the symptoms so that you can participate in a physical therapy program, become more active, and be better able to control the symptoms with a conservative program.
Your doctor is recommending an ESI to try and reduce your pain, numbness and weakness
In your legs. A mixture of cortisone and a local anaesthetic will be injected into the epidural space, close to an inflamed nerve. Cortisone, an extremely powerful anti-inflammatory, reduces the swelling of inflamed nerves, allowing them to function better.
The injections are temporary and may last from weeks to months. They do not help every patient, and sometimes a second or third ESI will be necessary, or the procedure may even be repeated 1 to 3 times per year if surgery is too risky. 60% of patients respond to only one injection and only 10-20% will require 3 injections.

How to prepare for the ESI

You may not eat or drink anything for 6 hours prior to the procedure. If you are uncertain whether to take your routine medication, please consult your doctor.
You must inform your doctor if you are routinely taking any medications that interfere with blood clotting. These include warfarin, heparin, Plavix, even an anti-inflammatory like aspirin and voltaren. Failure to do so, could lead to bleeding in the epidural space, a severe complication which could cause paralysis.
The procedure is usually done under sterile conditions in an operating theatre. You will most often be discharged on the same day, but someone will have to drive you home. You may not drive, but can resume normal activities, the following day.
Most doctors will arrange a follow-up appointment or telephone consultation, to assess your improvement.

The Procedure itself

An hour or so before you are taken to the procedure room; you may receive a pre-medication to relieve anxiety. An IV (drip) will be started to enable the doctor to administer any medication that may be needed during the procedure. This could include light sedation, or drugs to counteract problems, e.g. an allergic reaction.
The skin is anaesthetized with local anaesthetic, and then the epidural is performed. Some doctors make use of x-ray guidance. You will be taken to the recovery area and remain there until the attending doctor is satisfied that you are stable. You might experience some numbness or pins and needles in your legs, and must not attempt to walk until this feeling has subsided.

Possible Complications

The ESI is safe, but any medical procedure has possible complications. Only the more commonly occurring complications are described below:
1. A very low risk of an allergic reaction, as with any procedure where medication is injected
2. If the epidural needle punctures the Dura and enters the spinal sac, cerebro-spinal fluid may continue to leak into the epidural space, causing a severe headache (worsens when sitting or standing). This normally resolves after a few days, but it may be necessary to inject blood into the epidural space (blood patch), if the headache does not resolve.
3. An epidural Haematoma or bleeding occurs extremely rarely, but can lead to paralysis. If the numbness or pins and needles in your legs returns or persists,
Contact your doctor immediately.
4. An epidural abscess or infection can like no 3. put pressure on the nerves and may
Necessitate surgery.
5. Rarely, the needle , itself can cause nerve damage, which most often recovers
Spontaneously

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