Sacral Epidural Injections

You have been offered an epidural injection to help in the relief of your leg pain.An epidural injection is a day case procedure. You will come in the morning and you will probably be able to go home in the afternoon.

In this procedure a combination of local anaesthetic and steroid is injected into the epidural space in your spinal canal. The aim of the procedure is to try and reduce the inflammation of the nerves and discs.

The epidural space lies between the spinal canal and the outer wall of the spinal cord.

The injection itself is done under local anaesthetic. You will experience some discomfort during the injection, but it will not be too painful.

The needle is inserted at the base of your spine just near your coccyx. There is a small triangular opening there which allows us to access the spinal canal. We will put a small needle in and inject a radio-opaque dye initially which will confirm whether the dye is in the epidural space. We will then put the steroid and local anaesthetic through this needle.

IF YOU TAKE WARFARIN OR HEPARIN OR KNOW THAT YOU HAVE PROBLEMS WITH YOUR BLOOD CLOTTING PLEASE LET US KNOW BECAUSE THIS IS A CONTRA-INDICATION TO THIS PROCEDURE.

You will be asked to come to the Day Case Unit on the morning of the epidural injection, probably about 8 am or 10am . Your consent will be taken and you will have the injection on the morning.

RISKS OF EPIDURAL INJECTIONS

Epidural injections are relatively safe as compared to say open surgery. They do however carry some risks.These risks are very uncommon, but you need to understand and accept them before agreeing to have the injection done.

You could have an infection, which could result in meningitis. You could have damage to the nerves,which supply your bladder and bowel function though this effect may be temporary.This is very uncommon.

The injection on very rare occasions may be given inadvertently into a blood vessel and this can be fatal.This is very rare.

There are some case reports of haemorrhage in the eye and therefore if you have only one eye that is functioning properly you should speak to us because this may be a relative contra-indication to having the epidural injection.You may have some headaches after the epidural injection..

Retention of urine and inability to pass water is a well-known problem after epidurals.This is usually temporary, but may require you to stay in hospital overnight.

Occasionally epidural injections can make your pain worse, though this effect is also temporary.

You may feel some deadness in your legs initially and numbness in your buttocks, but this usually resolves once the local anaesthetic wears off.

LIMITATIONS OF THE EPIDURAL INJECTION

You must understand that the epidural injection though relatively safe and quick and easy to perform has the disadvantage of being unpredictable in its action and short lived in it’s effect.

Some patients don’t respond to the epidural injection.

In some patients who do respond and have pain relief after the injection, this effect may last from 4 - 6 months. You may require a subsequent epidural injection or we may need to consider other management options in your case.

POST OPERATIVE CARE

After you go home you may require some painkillers for the first 2 days because your pain may be slightly worse. The effects of the epidural are variable in their onset and so people notice immediate pain relief where in others it may take up to 10 days.