Corticosteroids are strong anti-inflammatory medications and, when placed into the epidural space, can significantly reduce inflammation around an irritated nerve that is causing back and leg pain and discomfort. An epidural steroid injection may be an effective nonsurgical treatment in itself or may aid in surgical planning. Epidural steroid injections work by delivering a potent anti-inflammatory to the site of nerve impingement in the spine.
Injected medications may include steroids, local anesthetics, and saline, and they can vary in volume and concentration on an individual basis. Your physician will choose which method is right for you based on your diagnosis and if you have had any prior spine surgeries. Epidural steroid injections are recommended to be administered up to three to six times per year.
In the case of a new disc herniation, injections may be only weeks apart with a goal of quick and complete resolution of symptoms. For chronic conditions, three to six months or more between injections is common. Epidural steroid injections can help resolve pain permanently in patients with a new disc herniation who respond favorably. For patients with chronic pain or recurrent disc herniations, the desired duration of effect is three to six months or more.
The risks in any procedure involving a needle include bleeding, infection and nerve damage. When performed properly, the risk of any of these is exceedingly low and usually outweighed by the potential benefit of the procedure. Some contraindications for performing epidural steroid injections include:. Common side effects include mild injection site pain, temporary worsening of usual pain, flushing, insomnia, or increased blood sugar. Closely related is spinal anesthesia, where a drug is injected into the cerebrospinal fluid of the spine.
Epidurals use a larger drug dose, work faster, and can be used anywhere within the vertebral column spinal injections are just for the area beneath the lumbar vertebral body. Unlike many other so-called alternative therapies, epidurals have a long and proven history. Outside of childbirth, epidurals can be helpful in reducing other types of back and leg pain, improving mobility, decreasing dependency on pain medications, and delaying or even avoiding surgery.
Though the medication might not harm these babies, they may have subtle effects on the newborn. The nerves of the uterus should begin to numb within a few minutes after the initial dose.
You will probably feel the entire numbing effect after minutes. As the anesthetic dose begins to wear off, more doses will be given—usually every one to two hours. Depending on the type of epidural and dosage administered, you can be confined to your bed and not allowed to get up and move around. If labor continues for more than a few hours you will probably need urinary catheterization, because your abdomen will be numb, making urinating difficult.
After your baby is born, the catheter is removed and the effects of the anesthesia will usually disappear within one or two hours. Some women report experiencing an uncomfortable burning sensation around the birth canal as the medication wears off. You might not be able to tell that you are having a contraction because of your epidural anesthesia. If you can not feel your contractions, then pushing may be difficult to control.
For this reason, your baby might need additional help coming down the birth canal. This is usually done by the use of forceps. For the most part, epidurals are effective in relieving pain during labor. Some women complain of being able to feel pain, or they feel that the drug worked better on one side of the body. Cunningham, F. Gary, et al, Ch. What is an Epidural? What is an epidural? How is an epidural given?
An antiseptic solution will be used to wipe the waistline area of your mid-back to minimize the chance of infection. A small area on your back will be injected with a local anesthetic to numb it. A needle is then inserted into the numbed area surrounding the spinal cord in the lower back.
After that, a small tube or catheter is threaded through the needle into the epidural space. The needle is then carefully removed, leaving the catheter in place to provide medication either through periodic injections or by continuous infusion.
The catheter is taped to the back to prevent it from slipping out. What are the different types? Regular Epidural After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space.
What are the benefits of epidural anesthesia? An epidural provides a route for very effective pain relief that can be used throughout your labor. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach.
Different off-axis angles pose the challenge in learning the technique.
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