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The epidural steroid injection usually takes about 15 to 30 minutes to
complete. The patient may sit and lean forward, or lie on his or her
stomach or side with the back arched. Prior to the injection, the skin is
numbed with lidocaine, a local anesthetic similar to the novacaine used by
dentists. Then the physician will locate the appropriate spot for the injection.
Using fluoroscopy (live x-ray) for guidance, the physician directs a
needle toward the epidural space. Fluoroscopy is considered important in
guiding the needle into the epidural space, as controlled studies have
found that medication is misplaced in 13% to 34% of epidural injections
that are done without fluoroscopy. Once the needle is in the exact
position, steroid solution is injected. At times a flushing solution, such
as lidocaine or normal saline, is also used to help “flush out”
inflammatory proteins from around the area that may be the source of pain.
Following the injection, the patient is usually monitored for 15 to 20
minutes before going home. Typically, patients are asked to rest on the day
of the injection and allowed to return to their normal activities on the
following day.
Potential risks and side effects
With all invasive medical procedures, there are potential risks. Generally,
however, there are few risks associated with epidural injections and they
tend to be rare. Risks may include:
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Infection. Minor infections occur in
1% to 2% of all injections. Severe infections are rare, occurring in 0.1%
to 0.01% of injections.
·
Bleeding. Bleeding is a rare
complication and is more common for patients with underlying bleeding
disorders.
·
Nerve damage. While extremely rare,
nerve damage can occur from direct trauma from the needle, or secondarily
from infection or bleeding.
·
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 gets better
within a few days. Although rare, a blood patch may be necessary to
alleviate the headache.
Paralysis is not a risk since there is no spinal cord in the region of
the epidural steroid injection.
In addition to risks from the injection, there are also potential risks
and side effects from the steroid medication. These side effects tend to be
rare. Risks and side effects may include:
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A transient decrease in immunity
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Transient flushing
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High blood sugar
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Increased appetite
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Stomach ulcers
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Severe arthritis of the hips (avascular necrosis)
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Transient flushing
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Lumbar epidural steroid injections should not be performed on patients
who have a local or systemic bacterial infection, are pregnant (if
fluoroscopy is used) or have bleeding problems. Epidurals should also not
be performed on patients whose pain is from a tumor or infection, and if
suspected, an MRI scan should be done prior to the injection to rule out
these conditions. Injections may be done, but with extreme caution, for
patients with allergies to the injected solution, uncontrolled medical
problems (such as congestive heart failure and diabetes), and those who are
taking aspirin or other antiplatelet drugs (e.g. Ticlid, Plavix).
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