Thoracic Epidural Injection
What is the epidural space?
The membrane that covers the spine and nerve roots in the neck is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the mid back and along the ribs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract with the bony structure of the spine in some way with the bony structure of the spine.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the mid back or around the rib cage. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.
What happens during the procedure?
An IV is started so that relaxation medication can be given. The patient is placed lying on their side on the x-ray table and positioned in such a way that the physician can best visualize the back using x-ray guidance. The skin on the back is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.
What happens after the procedure?
Patients are then returned to the recovery area where they are monitored for 30-60 minutes. Patients are then asked to record the relief they experience during the next week on a post injection evaluation sheet ("pain "diary"). This will be given to the patient when they are discharged home. A follow-up appointment will be made for a repeat block if indicated. These injections are usually done in a series of three (3), about two (2) weeks apart. The back or legs may feel weak or numb for a few hours. This is to be expected, however it does not always happen.
General Pre/Post Instructions
Patients can eat a light meal within a few hours before the procedure. If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure. Patients may take their routine medications. (i.e. high blood pressure and diabetic medications). Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients have to be hurting prior to this procedure. They may not take medications that may give pain relief or lessen their usual pain. These medicines can be restarted after the procedure if they are needed.