What is the epidural space and why is a selective epidural helpful?
The covering over the nerve roots in the spine is called the dura. The space surrounding this dura is the epidural space. Nerves travel through the epidural space before leaving the spine and traveling down your arms, along your ribs and into your legs. The nerves leave the spine from small nerve holes. Inflammation of these nerve roots may cause pain in your arms, chest or legs. These nerve roots may become inflamed due to irritation from a damaged disc or from contact with a bone spur. A selective epidural injection places anti-inflammatory medicine over the nerve root and into the epidural space to stop inflammation of the nerve roots, therefore hopefully reducing arm or chest wall or leg pain. The epidural injection may promote healing and speed up “mother nature”. Although not always helpful it reduces pain and improves function in the majority within 3-7 days. It may provide permanent relief or provide a period of pain relief that will allow other treatments like physical therapy to be more effective. We hope it will reduce your pain during the next several months while the injury/cause of your pain is healing. A selective epidural is also helpful for diagnostic reasons. If the nerve is numb after the procedure and the nerve is the reason for your pain you will feel immediately better and prove that nerve is your pain source.
What will happen to me during the procedure?
First an IV is started so that you may be given medicine for relaxation if you so desire. Next, while lying on an x-ray table your skin will be well cleaned. The physician will numb a small area of skin which may sting for a few seconds. Next, the physician will use x-ray guidance to direct a small needle above the nerve root as it leaves the boney nerve hole. He will then inject contrast dye to confirm that the medicine spreads to the affected nerve root(s) in the epidural space. After this, the physician will inject a combination of numbing medicine and time release anti-inflammatory cortisone.
What should I do after the procedure?
You will wait 30-45 minutes in recovery before going home. No driving for eight hours. You may have temporary numbness or weakness in your arm or leg for several hours after the procedure. Please record your pain relief during the next week on a “pain diary” we will provide to you. Mail the completed pain diary back to Advanced Pain Management. If you experience complete. or more than 90% relief, of your pain the procedure should not be repeated. If you experience partial relief it may be beneficial to repeat the procedure in about two weeks. If you experience no relief, notify the office and the procedure will probably not be repeated. We perform a maximum of three epidurals each 2 weeks apart.
General Pre/Post Instructions
You should eat a light, but not a full meal at least 2 hours before the procedure. If you are an insulin dependent diabetic do not alter your normal food intake. Take your routine medications before the procedure (such as high blood pressure and diabetes medications). Stop aspirin and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve, Relafen, Daypro) 3 days before the procedure. These medicines may be re-started the day after the procedure. You may take your regular pain medicine as needed before/after the procedure. If you are on coumadin, heparin, lovenex, plavix or ticlid you must notify my office so that the timing of stopping these medications can be explained. If you are on antibiotics please notify our office, we may wait to do the procedure. If you have an active infection or fever we will not do the procedure. You will be in the hospital as an out-patient for 2-3 hours even though you see the physician for 20 minutes. You will need to bring a driver with you. You may return to your current level of activities the next day including return to work.