Epidural injection into the lower spine
An epidural injection is usually where a mixture of a steroid and a local anaesthetic is injected into the epidural area (or space) of the spine. This is the region in the spine where the nerve roots travel before leaving to go on and supply your legs.
The steroid part of the injection works as long-term localised anti-inflammatory. The local anaesthetic is mainly to help with discomfort immediately after the injection.
Typically it aims to reduce inflammation around a nerve or nerves, allow a reduction of symptoms and allow the patient to lead a more normal life and/or begin a physical rehabilitation program.
Occasionally it is done to ease back pain if it is felt the areas contributing to the back pain are in the epidural space.
The two most recognised & accurate ways of performing the injection are a ‘lumbar epidural’ or a ‘sacral or caudal epidural’. Both of these techniques are undertaken by Mr Cass. He will usually offer the technique that is most suitable for your individual case.
Both the types of injection are performed as a day-case in the operating suite. Mr Cass only performs these in the operating suite: In this way the risks of any infection are minimised and a close eye can be kept on the patient for 30 minutes or so following the injection.
In a lumbar epidural, a needle is introduced under local anaesthetic directly into the lower back (very similar to what a pregnant lady may have during labour). When the needle is in position, the mixture of steroid & anaesthetic is injected and the needle withdrawn.
In a caudal (or sacral) epidural the patient is positioned face down on the operating table with pillows. The patient usually then receives some sedation medicine and drifts briefly to sleep. While asleep Mr Cass uses X-rays & a dye to guide the needle into the correct position, just near the top of your buttocks. When the needle is in position, the mixture of steroid & anaesthetic is injected and the needle withdrawn.
With both injections it is common for your legs to feel a bit tingly or warm for a few hours. This is perfectly normal and usually a good sign that the mixture is in the right place. Very occasionally your blood pressure may fall a little but will be checked before you are allowed to go home.
For the remainder of the day following an epidural, you should take it easy at home. No driving or physical undertaking should be undertaken as your legs can feel a little wobbly. The following day normal activities can be returned to.
The steroid used is slow but long acting. It may be several days before you feel a benefit from the injection.