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Research studies have shown the benefit of epidural
steroid injections for spinal disc lesions causing
sciatica.
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 an out patient or day
case procedure without the need for overnight
stay or general anaesthetic.
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 may experience some temporary light headedness
and slight unsteadiness in the legs until the
local anaesthetic wears off. For this reason you
should not drive a vehicle or operate machinery
until the next day. 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.
By feeling for the bones of the sacrum, the physician
will identify the base of the sacrum before administering
the injection. He may have an nurse/assistant
who helps during the procedure. so that the therapist
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.
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. You will need a competent adult
to drive you home. If you are living alone, please
ensure you have a competent adult to take care
of 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. Most people leave
the Clinic within one hour of their appointment.
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