Epidural Steroid Injection
What is an Epidural Steroid Injection?
How is this injection done?
Although there are different techniques used for Epidural Steroid Injection, the most common technique employed by interventional pain management specialists now is with X-Ray guidance (fluoroscopy), usually with the patient lying on his or her stomach. Dr. Zeballos uses fluoroscopy for all of his ESI procedures. The injection is performed under local anesthesia and, on occasion, with intravenous sedation. Patients are not deeply sedated or completely asleep for this procedure because it is unnecessary and unsafe to do so. The procedure usually takes no more than 5-10 minutes, followed by a brief 15-20 minute recovery before discharge home.
What types of conditions will respond to Epidural Steroid Injection?
For over forty years, ESI has been used to effectively treat chronic neck and back pain as well as a variety of other conditions. The most common diagnoses treated with ESI include herniated or bulging discs, spinal stenosis, and recurrent pain following spine surgery. Other conditions that may also respond to ESI include spondylolisthesis (slippage of the vertebral column) and post-herpetic neuralgia (pain after shingles).
Does the injection hurt?
The injection of local anesthetic (numbing medicine) at the beginning of the procedure may sting some, but ESI is an otherwise routine procedure that is extremely well tolerated by patients ranging in age from the mid-teens to well over ninety years old. If you are anxious or concerned about pain during the procedure, please discuss with Dr. Zeballos the possibility for your receiving intravenous sedation.
What should I do to prepare for my injection?
On the day of your injection, you should not have anything to eat or drink for at least eight (8) hours before your scheduled procedure. If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure.
If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.
What should I expect after the injection?
You may notice some reduction in your pain for the first 1-2 hours after the injection if local anesthetic is injected with the steroid. When this anesthetic wears off, your pain will return as it was before the procedure. Although pain relief with ESI generally occurs within 3 - 5 days, some patients experience improvement before or after this time period. Diabetic patients should be on the alert for a rise in blood sugar during the first few days after injection and must monitor blood sugar accordingly.
What should I do after my injection?
Following discharge home, you should plan on simple rest and relaxation. If you have pain at the injection site, application of an ice pack to this area should be helpful. If you receive intravenous sedation, you should not drive a car for at least eight hours. Patients are generally advised to go home and not return to work after this type of injection. Most people do return to work the next day.
How many injections will I need during my treatment?
A typical injection series consists of three injection sessions with an interval of two weeks between each session. However, the number of injections that you may require will depend on your response to each individual injection. If you have no pain following one injection, you will probably not need any additional treatment. Alternately, if you have absolutely no pain relief after two injections, Dr. Zeballos may recommend a different treatment for your pain. Please note that the alternatives to Epidural Steroid Injection may, in some cases, involve vastly different treatments such as Facet Joint Injection, Sacroiliac Joint Injection, Percutaneous Disc Decompression or even surgery. If you are not sure whether you should have your next procedure or if you feel that a different type of injection or treatment should be considered, please contact Dr. Zeballos’s staff well in advance of your next appointment to discuss your situation.
Could there be side effects or complications?
Minor side effects from the injected medications are not uncommon and can include nausea, itching, rash, facial flushing and sweating among other things. Some patients notice a mild increase or worsening of their pain for the first day or two after injection. Fortunately Epidural Steroid Injection has an extremely good safety profile, and serious complications are quite rare. Just like any other medical procedure, there are potential complications associated with ESI. Dr. Zeballos will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed.
What are the chances that this treatment will help my pain?
Most studies show that this treatment helps relieve pain for approximately half (50%) of the patients treated. The degree and duration of pain relief are variable and depend on many different factors, including the underlying diagnosis or condition being treated, duration of symptoms before treatment, whether previous back (neck) surgery has been performed and other factors.
Can these injections be repeated if my pain returns?
YES! This ESI can definitely be repeated if it was helpful for your pain in the past. Although there is some flexibility in the timing of repeat injection, Dr. Zeballos will probably want you to wait for at least four to six months after your last injection. This issue can be discussed during a follow-up office visit.
ESI Patient Information Pre-surgical
Epidural Steroid Injection (ESI) Your referring physician has requested that you have an epidural steroid injection. The following is a description of the procedure and a description of the potential complications, so that you can give informed consent to have the procedure. An epidural steroid injection (or ESI) is an invasive procedure with some uncommon risks, so you will need to give informed consent. Local anesthesia (numbing medicine) will be injected underneath your skin. A needle will be placed with fluoroscopic (x-ray) guidance into the spine along the fibrous fluid-containing sac that contains the lumbar nerve roots. A small of contrast (x-ray dye) will be injected to confirm correct needle placement. Then an injection of steroids will be made into the same location. You will then be monitored for potential complications in the hospital for a short time after the procedure (usually about 30 minutes) until you are discharged. You will be able to eat and drink as well as use the bathroom while in the hospital after the procedure. Most complications of epidural steroid injections are rare and the procedure is very safe. You need to know the potential complications, which include:
As with all needle procedures, bleeding can occur. As long as you have no bleeding tendency and are not on any blood-thinners such as Coumadin, bleeding complications are extremely rare. However, patients have rarely had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after needle procedures like epidural steroid injections.
Any needle passing through the skin can introduce infection, which in an epidural injection would be meningitis. This is an extremely rare complication and sterile technique will be used.
This is a rare complication that may occur if a small hole is made in the fibrous sac and does not close up after the needle puncture. These small holes are only made in less than 1% of epidural injections and usually heal on their own. The spinal fluid inside can leak out, and when severe, the brain loses the cushioning effect of the fluid, which causes a severe headache when you sit or stand. These types of headaches occur typically about 2-3 days after the procedure and are positional - they come on when you sit or stand and go away when you lie down. If you do develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill and have no fever and the headache goes away when you lay down, you may treat yourself with 24 hours of bed rest with bathroom privileges while drinking plenty of fluids. This almost always works. If it does not, contact the radiologist who performed the procedure or your referring physician. A procedure (called an epidural blood patch) can be performed in the hospital that has a very high success rate in treating spinal headaches.
STEROID SIDE EFFECTS
Epidural steroids may rarely produce unwanted side effects. Some of these potential side effects include increased blood sugar or hyperglycemia (especially in diabetic patients), fluid retention, elevated blood pressure, and transient redness or facial flushing. (Side effects from steroids may be common if they are taken daily over a length of time, rather than as an isolated epidural injection.)
The use of any medication, including x-ray contrast, has the possibility of producing an allergic reaction. Please inform your physician of all of your known medical allergies before the procedure. If you have any questions, please feel free to ask the physician performing the procedure prior to signing the consent form.
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