In case a patient is suffering from pain or inflammation in the spine or extremities, i.e. arms and legs, the doctor or healthcare professional can administer an Epidural Injection.
The epidural injection will help to provide temporary or lasting relief from such pain or inflammation.
The help of imaging guidance that a radiologist will use to place the needle in the right location provides maximum benefits.
Moreover, the injection also helps confirm the exact site of the pain.
The doctor will instruct on how a patient can prepare and advise on the changes related to a regular medication schedule.
Also, the doctor can tell the patient about what they can eat or drink several hours before the procedure.
It is important for the patient to inform the doctor if they are pregnant.
Keep on reading to learn more about Epidural Injection.
Epidural Injection
An epidural injection is an injection of medication into the space around the spinal cord or epidural space.
It helps to provide temporary or prolonged relief from pain or inflammation.
Moreover, the epidural space is the outermost part of the spinal canal.
A doctor or health care provider can administer steroids, anesthetics, and anti-inflammatory medications in an epidural injection.
This injection can help reduce pain and swelling in and around the spinal nerve roots, and around the damaged nerves which in time can heal.
With the help of an imaging guide like fluoroscopy, i.e. multiple X-ray images or computed tomography, CT, or CAT scan, the doctor can place the needle in the right location to target a specific area.
This area may be the one causing pain so that the patient can receive maximum benefit from the injection.
Uses of Epidural Injection
An epidural injection is one of the several methods a doctor can use to help relieve pain, along with physical therapy, oral medications, and surgery.
This is especially the case when the patient is not responding to conservative methods.
Moreover, a doctor can perform an epidural injection for medical conditions to alleviate the pain that occurs due to:
- herniated disc or bulging dish that impinges nerves causing pain
- spinal stenosis or narrowing of the spinal canal
- post-operative, ‘failed back’ surgery syndromes, or chronic back or leg pain after spinal surgery
- other injuries to the spinal nerves, vertebrae, and surrounding tissues
- bone spurs
What does the Equipment look like?
The injection itself can be administered with the help of a syringe, much like the one a doctor can use for routine vaccination.
The doctor will fill the syringe with a small vial of medication, and the type of medication depends on the individual patient’s needs.
Moreover, the help of imaging guidance, like fluoroscopy, or CT scan will be the additional equipment a doctor can use.
Both types of imaging are painless and will involve the use of an x-ray to obtain essential images.
These images allow the doctor or health care provider to place the needle exactly in the right location of the area of interest for the injection.
This exam often uses a radiographic table, one or two x-ray tubes, and a video monitor.
With fluoroscopy, the machine converts X-rays into video images.
Doctors can use it to watch and guide procedures.
However, an x-ray machine and a detector suspended over the exam table will produce the video.
On the other hand, a CT scanner is a large, donut-shaped machine with a short tunnel in the center.
The patient will need to lie on a narrow table that will slide in and out of the tunnel while rotating around the patient, the x-ray tube, and electronic x-ray detectors are present opposite one another, called a gantry.
The computer workstation that will process the imaging information is present in a separate room.
This is where the technologist will operate the scanner and monitor the patient in direct visual contact.
Furthermore, the technologist will be able to hear and talk to the patient using a speaker and microphone.
Preparing for the Procedure
The patient will receive special instructions on how they can prepare for the procedure.
These include any changes that patients may need to make to their regular medication schedule.
Moreover, the doctor or health care provider will instruct them to not eat or drink anything for several hours before a procedure.
This will help to prevent the patient from having an upset stomach following the injection or because some canters may offer sedation during the procedure.
The patient may need to change into a hospital gown for the procedure and the doctor may ask them to use the restroom before the procedure.
Furthermore, the doctor will tend to position the stomach of the patient or side on special fluoroscopy or CT take that will give them access to the injection site.
A nurse and/or technologist will help to make the patient as comfortable as possible, both during and after the procedure.
However, it is important for the patient to have someone drive them home after the procedure.
How does the Procedure Work?
It is important to note that different types of medications a doctor will slowly inject into the epidural space create different effects for different patients.
Epidural Corticosteroids injections or epidural steroid injections ESIS act as anti-inflammatory agents that help to reduce swelling and nerve irritation.
Moreover, these allow the nerve time to heal itself, thereby, preventing any further discomfort.
By delivering an epidural injection directly into the epidural space, the medication will move throughout the space, coating the inflamed or irritated nerve root.
Therefore, a lumbar, or lower back injection can help alleviate the pain that comes with the lower back and the nerves traveling to the lower limbs, like in the case of the sciatica nerve.
In the same way, if the doctor performs an epidural injection in the neck, it will spread throughout the cervical epidural space.
There it will provide relief to nerve roots in the neck which can help relieve arm pain, according to Treasure island fl statpearls publishing.
It is important to note that the duration of improvement from the epidural injection varies.
Some patients may have permanent relief, while for others, the effects may not last long.
Furthermore, in some cases, the patient can have a series of injections before they benefit from significant relief.
A patient, however, can experience relief in a matter of days to several months.
But the pain may return, requiring another series of injections or an alternative treatment.
Performing the procedure of Epidural Injection
In most cases, the doctor will perform this procedure on an outpatient basis.
However, in some cases, a patient may require administration following the procedure, thus, they should ask the doctor they need to be admitted.
It is important to note that epidural injection only takes a few minutes to administer, but positioning the CT or x-ray can take longer.
When the patient arrives at the hospital or surgical center, the nurse or technologist will place an intravenous, IV line in the arm to deliver relaxation medication during the procedure.
This is seldom needed but will be available, according to to curr phys med rehabil rep.
The patient will then lie on their stomach or the side of the table in the fluoroscopic room or a CT scan room and will be made comfortable as possible.
Then the doctor will identify the site where they need to inject the injection, and clean and sterilize the skin with an antiseptic solution.
Local anesthetics is injected to help numb the area before administering the epidural injection.
Once the area is numb, the doctor will use imaging guidance to help guide the epidural nerve to exactly the right position.
When the needle is in place, the doctor will inject a contrast material so that they can accurately target the nerves for sufficient distribution of medication.
Then, they will slowly inject the medication, which is often a combination of anesthetics and anti-inflammatory drugs, i.e. cortisone/steroids.
Lastly, the nurse will move the patient into the chair or bed and allow them to rest for a few minutes to an hour.
The nurse or technologist will make sure that the patient does not experience any unfavorable reactions to the medications before they leave.
What will the Patient Experience?
It is important to note that the patient will have no sensation whatsoever, however, they may experience tingling or pressure when the doctor administers the injection.
Depending on the amount of swelling in the area, the patient may experience a burning sensation at the site or in the upper or lower extremities or some mild discomfort as the medication enters the epidural space.
When the injection is finished, any discomfort will disappear.
It is also possible for the patient to feel “pins and needles” in their arms and legs, depending on the injection site.
However, if they experience any sharp pain, they should seek medical advice immediately.
Due to numbness, and any discomfort, the patient can experience difficulty walking on their own and getting in and out of the car.
This is normal and will subside in a matter of hours.
It is important for the patient to take it easy for the rest of the day, though they can resume normal activities the next day.
The epidural may not take effect immediately, it is common for improvement in the pain to occur progressively over the first 48 hours.
The effect can last for a matter of days, weeks, and occasionally months.
While in some patients, the pain will initially feel slightly worse before it starts to improve, and it is also necessary to have a series of epidural injections to fully improve.
Interpreting the Results
A radiologist or anesthesiologist will most likely perform an epidural injection, however, a neurosurgeon, orthopedic surgeon, or neurologist can also administer it.
The doctor who will administer the injection will also follow up with the patient to see how they are doing and find out if any further action is needed.
However, any imaging that they perform during the procedure itself will conclude the procedure and no follow-up image interpretation is important.
The interventional radiologist may recommend a follow-up visit.
This visit can include a physical check-up, imaging exams, and blood tests.
During this, it is important for the patient to tell the doctor if they experience any side effects or changes.
Benefits vs. Risks of Epidural Injection
Benefits
Some benefits of epidural injection are:
- temporary or prolonged pain relief
- reduction of inflammation in the region of the spine causing pain
- improvement in the ability to perform daily activities without restrictions previously caused by pain
- help confirm the origin of pain and is often a problem in patients with more than one possible cause of pain
- reduce the need for invasive procedures
Risks
Some risks of epidural injections are:
- increase in pain temporarily
- headache can be extreme rarely, but possible
- reaction to the medications like hot flashes or rash
- infection at the site of injection
- bleeding if the blood vessel is inadvertently damaged
- injury to the nerves at the injection site
Moreover, some other potential risks can be temporary paralysis of the nerves leading to the bladder and bowel, causing temporary bladder or bowel dysfunction, and when a doctor uses fluoroscopy or CT, they will be minimal low-level radiation.
Women should always inform the doctor or technologist if they are pregnant.
Doctors will not perform any tests during pregnancy to avoid exposing the fetus to radiation.
However, if an x-ray is necessary, they will take precautions to minimize radiation exposure to the baby.
When the doctor administers epidural injection in the neck, some serious complications like spinal cord injury, stroke, or even death are possible if they place the needle incorrectly.
But as the doctor uses imaging guidance and a sterile technique, it minimizes these risks.
