Prior to the procedure the patient should review the pre-injection instructions. Certain medications may increase the risks of complications (bleeding). Please inform you doctor if you are taking any of the following:
- Aspirin 325 mg- stop 7-10 days before the injection. A baby aspirin can be continued
- NSAIDs- Ibuprofen (Advil), Naprosyn (Aleve), Diclofenac, Meloxicam, Indocin, etc- stop 3 days before procedure
- Coumadin (Warfarin)
- Plavix (Clopidogrel)
- Ticlid (Ticlopidine)
- Lovenox (Enoxoparin)
- Eliquis (Apixaban)
- Brilinta (Ticagrelor)
- Xarelto (Rivaroxaban)
- Pradaxa (Dabigatran)
Continue with your routine medications before the procedure. If you have an infection please notify your physician. It is best to wait for it to resolve before getting your injection. There is no eating for six hours before and no drinking for 2-4 hours before the procedure. Small amounts of clear liquids are allowed up to two hours before and can be used to take your pills if necessary.
What to expect the day of the injection
Patients are generally asked to be at the surgical center one hour prior to the procedure and can expect to be at the facility approximately 2-3 hours. A driver must accompany the patient and be responsible for getting them home. No driving is allowed the day of the procedure. Patients may return to their normal activities the day after the procedure, including returning to work unless otherwise directed by their doctor.
In the pre-operative area a nurse will interview you and place and IV in your arm. This allows you to receive a relaxing and/or pain medication during the procedure if necessary. You will be lying on your stomach and your back will then be cleaned prior to beginning the injection. The skin and underlying tissues will then be numbed with an anesthetic (lidocaine). This can sting for several seconds. Using fluoroscopy (x-ray) a small needle will be placed in the epidural space. Prior to injection of cortisone, a contrast agent (dye) is used to determine the proper placement of the needle. After correct localization of the needle is performed, a mixture of an anti-inflammatory (cortisone/steroid) and a anesthetic (lidocaine) is then injected. Sometimes, patients feel an increase in leg pain in the exact area that they have been feeling pain. If pain is increased the pace of the injection of the medication is slowed to make it more tolerable.
Post-injection you will be taken to the recovery area and observed for 30-60 minutes. You will be given post-injection instructions to read and follow. Once it is determined that your vitals signs are stable, you are discharged home with your driver. You will be asked to follow up in the office in 10-14 days.
After the procedure, it can take up to two weeks to achieve relief from the symptoms. However, most people feel a benefit from the injection in 3-5 days.
There are several risks associated with epidural injections, and although they are all very uncommon it is worth discussing each with the physician who will be performing the procedure.
As with all invasive medical procedures, there are potential risks associated with lumbar epidural steroid injections. In addition to temporary numbness of the bowels and bladder, the most common potential risks and complications include:
- Infection – Severe infections are rare, occurring in 0.1% to 0.01% of injections.
- Dural puncture (“wet tap”) – A dural puncture occurs in 0.5% of injections. It may cause a post-dural puncture headache (also called a spinal headache) that usually improves within a few days. Although infrequent, a blood patch may be necessary to alleviate the headache. A blood patch is a simple, quick procedure that involves obtaining a small amount of blood from an arm vein and immediately injecting it into the epidural space to allow it to clot around the spinal sac and stop the leak
- Bleeding – Bleeding is a rare complication and is more common for patients with underlying bleeding disorder
- Nerve damage – While extremely uncommon, nerve damage can occur from direct trauma from the needle, or from infection or bleeding.
- There have been reports in the medical literature of very rare complications from epidural steroid injections in the neck that include stroke, paralysis, vision loss and death. These complications have been associated with certain medications injected and the incorrect place of the medication. The choice of cortisone (steroid), the use of fluoroscopy (x-ray) and other precautions are taken to greatly minimize the risk. The FDA recommends only the use of a water soluble steroid (dexamethasone) when performing cervical transforaminal epidurals.
Side Effects from Corticosteroids
All corticosteroids have potential side effects. These tend to range from uncommon to rare but can occur and you need to be aware of them. They are usually much less prevalent than the side effects from taking oral steroids.
- Facial flushing
- Fluid retention
- Elevated blood pressure
- Fever the night of injection
- Elevated blood sugar for 2-3 days- diabetics need to monitor their blood sugars closely
- A transient decrease in immunity because of the suppressive effect of the steroid
- Heartburn/stomach ulcers
- Severe arthritis of the hips (avascular necrosis)
- Post-injection flare – an increase in pain that can occur several hours after the injection and can last for several days