Dr Raghu Sudarshan Thota – MD (Anaesthesiology)
We will start from where we left last week. Yes, you sure will be pain free without surgery, but one thing should be kept in mind:
These injections are an alternative form of treatment, which allow participation in an active exercise programme and may assist in avoiding the need for surgery.
Epidural Corticosteroid Injections
Epidural space is a potential space in the spinal cord, free of the nerve roots coming out of the spinal cord. Epidural Steroid Injections (ESIs) are a combination of drugs injected into this potential space under x-ray guidance in the operation theatre. ESIs have been endorsed by the North American Spine Society as an integral part of nonsurgical management of nerve pain from lower spine disorders.
ESIs have been shown to be effective in pain reduction in patients with nerve pain generated by the compression of nerve routes in the spine
Benefits of the ESI include :
■ relief of nerve pain generating from the spinal cord
■ relief of low back pain
■ ability to participate in physiotherapy
■ improved quality of life
■ reduction in the use of pain killers.
When performed by a skilled, experienced clinician in an appropriate setting and with carefully selected patients, the chance of significant complication from ESIs is remote. Nonetheless, similar to regional analgesia procedures, there are risks associated with ESIs. The more common risks from lower back epidural injections are as follows:
■ Headache
■ Nausea
■ Vomiting
■ Dizziness
■ Bleeding along the path of the injection, which is a rare but potentially serious
complication.
■ Infection.
■ Nerve root injury
The interval between injections varies with the preparation used. Doctors and patients often must consider the number of ESIs that should be performed. Usually an ESI is repeated at an interval of three to six months.
It is not necessary for most patients to undergo a set number or “series” of injections. If minimal to no improvement is found after two injections, then further injections are not warranted.
All patients should be followed up ten to 14 days after the injections to assess therapeutic response.
What will happen to me during the procedure?
If needed, an intravenous cannula will be started so that adequate pain relief medication can be given. You will lie on an x-ray table, where the skin over your lower back/buttock will be cleaned. Next, the physician will numb a small area of the skin with a numbing medicine (anaesthetic) which stings for a few seconds. The physician then will use x-ray guidance to direct a very small needle into the joint. He will then inject several drops of contrast x-ray dye to confirm that the medication goes into the joint. A small mixture of numbing medication (anaesthetic) and anti-inflammatory steroid preparation will then be slowly injected.
What should I do and expect after the procedure?
Twenty to 30 minutes after the procedure, you will move your back to try to provoke your usual pain. You may or may not obtain improvement in the first few hours after the injection.
You may begin to notice an improvement in your pain one to three days after the injection. If you do not notice an improvement within ten days after the injection, it is unlikely to occur. You may take your regular medications after the procedure, but try to limit them for the first four to six hours after the procedure, so that the diagnostic information obtained from the procedure is accurate. You may be referred for physical or manual therapy after the injection while the numbing medicine is effective and/or over the next several weeks while the medication is working.
On the day of the injection, you should not drive and should avoid strenuous activity. On the day after the procedure, you may return to your regular activity. When your pain has improved, you can start your regular exercise/activities in moderation. Even if you improve significantly, you should be slow in increasing your day-to-day work to avoid recurrence of your pain.
