ESI-TFI
What is an epidural injection?

An epidural injection involves the injection of a corticosteroid (cortisone) and local anaesthetic into the epidural space of the spine; which is the area between the protective covering (dura) of the spinal cord and the bony vertebrae. The epidural space contains fat, nerve roots and small blood vessels.

This injection is used to reduce the pain associated with conditions such as spinal canal stenosis, spondylosis, herniated disc, degenerative disc or sciatica.

This injection procedure aims to reduce the inflammation of the spinal nerves and therefore reduce your pain to enable you to move or exercise more easily.

 

What is a Nerve Root Injection?

A nerve root injection or transforaminal injection involves the injection of a corticosteroid (cortisone) and local anaesthetic into the foramen (channel) from which a spinal nerve exits the spine.

This injection is used to reduce the pain associated with conditions such as spinal herniated disc or foraminal narrowing by disc herniation or facet joint hypertrophy.

This injection procedure aims to reduce the inflammation of the nerve root and therefore reduce your pain to enable you to move or exercise more easily.

 

How long could the pain relief last after this procedure?

These injections may provide pain relief for several weeks and even months. Sometimes though they only last for a few hours but this can still provide valuable diagnostic information. This procedure does not give permanent pain relief as the effects of the medication do eventually wear off. Adding a pulsed radiofrequency component to the nerve root injection often increases the duration of pain relief (ask your doctor).

 

Will I be awake during the procedure?

All of our patients are offered the choice of having sedation during the procedure. This is often a popular choice, as it can reduce the feeling of discomfort. After the procedure, it is highly likely you will have little to no memory of what happened.

 

Is the procedure painful?

To alleviate pain, numbing injections are administered at the start of the procedure. However, patients may still feel a slight discomfort during the procedure.

 

How do I prepare for the procedure?

The important thing to do when preparing for your procedure is to tell our medical staff if you are:

  • Taking blood thinners. These will need to be stopped for some time prior to the completion of the procedure.
  • Diabetic.
  • Pregnant, or have any chance of being pregnant
  • Are allergic to iodine, latex, shellfish, local anaesthetics or suffer from any other allergies
  • Are or have been feeling unwell or suffering from an infection
  • Have been implanted with a medical device

 

Prior to starting your procedure, you may find you will be advised by medical specialists to:

  • Fast for 6 hours before the procedure
  • Avoid liquids, including water, cordial, and tea, for 3 hours before your procedure
  • Continue taking medication, unless previously advised to halt usage
  • Ensure someone is available to transport you home after the procedure

 

What does the procedure involve?

It is important that patients know what to expect before arriving for their procedure. On the day, you will:

  • Arrive and complete the provided paperwork
  • Have a conversation with the anaesthetist if you are being sedated
  • A sterile tube, known as a small cannula, may be inserted into one of your veins
  • It may be necessary to give you a mild sedative and some pain killer through the vein
  • During the procedure, your heart rate, blood pressure and oxygen levels will consistently be monitored
  • Once you are lying face-down on the x-ray table, the skin over the area to be injected will be cleaned with an antiseptic solution, with sterile drapes also being applied.
  • At this point a local anaesthetic may be injected into your skin
  • Using an x-ray machine, a small needle will be guided towards the correct target. On some occasions, it will be necessary to use x-ray dye to confirm the needle’s position.
  • A local anaesthetic and/or steroid solution will be injected.
  • Further injections may also be required.

In total, the procedure usually takes between 20 and 30 minutes, as well as recovery time.

 

What are the potential complications?

We want to assure our patients that this procedure is generally very safe to undertake. However, it is an invasive procedure which carries the risk of complications. These include:

  • Puncture of the dura (the layer surrounding the spinal cord), with subsequent severe, but temporary, headache
  • Discomfort from where the injection took place
  • Infection
  • Bruising
  • Muscle weakness
  • Bleeding
  • Allergic reaction to medications given during the procedure
  • Extremely rare instances can result in permanent damage to nerves or spinal cord. This can result in weakness, pain or loss of sensation.
  • Failure of the procedure to result in a reduction of pain.
  • Side effects from the use of steroids including a flushed face, mood swings and high blood pressure, particularly in diabetics. These steroids were not specifically designed to be used in this procedure. However, they have been used extensively for many years without significant complications.
  • For any further risks from sedation, please consult your doctor.

 

What happens after the procedure?

  • For 60-90 minutes following the procedure, you will be monitored in a recovery area. You will then be free to go home.
  • If you were sedated, someone will be required to transport you home and remain with you overnight. A normal side effect of sedation includes not being able to remember certain information during the procedure.
  • You should avoid consuming alcohol, driving motor vehicles, operating machinery, signing legal documents, making important decisions or travelling alone for the 24 hours following your procedure.
  • When you wash the following day you will be able to remove your dressing.
  • You may notice the recurrence of pain once anaesthetic wears off. You may notice pain and stiffness will occur for the next 1-2 days. To remedy this, use ice packs for 10 minutes at a time. Otherwise, use painkillers to ease discomfort.
  • You may notice side effects from steroids. This includes face flushes, mood changes and a rise in blood sugar levels.
  • Ensure you do not rapidly engage in strenuous physical activity. Rather, gradually reintroduce physical activity into your daily routine.
  • You may be given a pain relief chart to fill out. Make sure you keep this handy to refer to when a QPain nurse phones you. The nurse will call 24-48 hours after the procedure to discuss the outcome and organise any necessary follow up appointments.
  • Please see QPain, your General Practitioner or, if needed, the Emergency Department if you have any severe pain, swelling, discharge or bleeding from the site or have any other concerns.

 

Consent

Prior to requesting the procedure, ensure you are completely informed and have no unanswered questions or concerns.

Once you have requested the procedure, you will be presented with a form of consent to sign. This states that you are aware of any benefits, risks, alternatives and the likely course of events which will occur if you do not proceed. If you change your mind, you are able to withdraw consent at any stage right up until the start of the procedure.

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