Research studies have shown the benefit of epidural steroid injections for spinal disc lesions causing sciatica. Although some studies have shown equivocal benefit.

The purpose of the injection is to carry the medicine to the inner part of the back where the more serious types of strain, affecting the discs or joints, cause pressure or irritation of the nerves. The structures are bathed by the anti-inflammatory steroid to reduce swelling and pain.
The solution contains a mixture of saline and corticosteroid (not depomedrone). It may be injected by the caudal route (just above the tail-bone) or between the spinous processes. The injection can be performed safely as day case procedure without the need for overnight stay or general anaesthetic.

“Kenalog (triamcinolone) is a drug which is licensed for many procedures but not for use in the epidural space. In spite of this it is used very frequently in most hospitals in the country in this way and the lack of licensing is the result of a pharmaceutical company being reluctant to spend money on licensing for a route of administration which does not represent a large proportion of their total production of this drug. Nevertheless, it is widely recognised to be an acceptable route of administration for this particular product

In the majority of cases it is not a painful procedure although you may experience some feeling of pressure as the volume of fluid is pushed in, or reproduction of your sciatic pain temporarily. After the procedure you will be expected to rest for a while (20 minutes or longer) before going home. (you will NOT become numb below the waist as in epidurals given during labour)

The benefit may appear almost immediately or build up gradually over a week or ten days. It is extremely unlikely that you will experience any other significant side effects.

Because of the corticosteroid component some woman may develop a
facial flush the next day which lasts 12-24 hours and more rarely some disruption of the menstrual cycle for one or two cycles. Other possible complications are similar to those of any injection and very rare, namely infection or allergic reaction which can occur in approximately 1 in 7,000 cases and can be dealt with promptly. There is no satisfactory evidence of any long term complication from epidural steroids.

EPIDURAL INJECTION

By feeling for the bones of the sacrum, the physician will identify
the base of the sacrum before administering the injection. He/she may have an nurse/assistant who helps during the procedure, so that he/she can place the needle correctly. The anaesthetic and steroid solution is then injected slowly over a period of about ten minutes.

The needle enters the spinal canal through the base of the sacrum, and the saline mixed with steroid penetrates up the canal to reach the level of the third lumbar vertebra.

If the pain relief is short-lived but significant, the epidural may be repeated to give a longer-lasting effect, so do not be too disappointed if the pain eventually returns after the first injection.
Your pain may be the same, or worse in some cases than before the procedure. This will last for 24-48 hours and is part of the normal process.

WHAT TO DO


If you are having a caudal epidural, please only drink clear fluids for four hours prior to the procedure (unless you are an insulin dependent diabetic). Take your usual regular medication with sips of water.
The procedure you are undergoing should/will have been fully explained to you before your appointment. If you have any further questions, please ask.
Please report any known allergies. (drugs, elastoplast etc) to the doctor, prior to the procedure.
We recommend that you are accompanied by a relative/friend who can drive you home after the procedure, (and stay with you until the following day)
After any procedure, it is advisable to go home and rest (preferably lying down) for the remainder of the day and preferably the next day too. (The doctor will guide you in the exact amount of rest needed.) Sitting and any long car journeys are to be avoided.
If in the rare event you do experience any untoward reaction in the following 24 hours, such as shortness of breath, dizziness or severe headache, please contact the Clinic immediately, or if it is out of hours, contact you GP or the Accident and Emergency Dept of your local hospital.