Epidural steroid injections may be performed in a surgery center, hospital, or a physician’s clinic. An anesthesiologist, radiologist, neurologist, physiatrist, and surgeon may be qualified to perform such procedure, though it is more beneficial to find a center and physician that specializes in back pain management.
Before the procedure, the patient will be asked to change into a hospital gown for the physician to have easier access to clean the injection area, as well as to visualize the injection site. The procedure may take 15-30 minutes. The standard protocol is listed below:
- Patient lies flat on an x-ray table or with his back slightly curved with the help of a small pillow under the stomach. The patient may be allowed to sit or lie on his side if the prior position causes him pain.
- Patient’s low back area is cleaned and given a local anesthetic to numb the area.
- Fluoroscopy will be used to guide the physician during the procedure.
- A needle is inserted directly into the epidural spine.
- Once the needle is positioned properly, contrast is injected to confirm the needle location.
- The epidural steroid solution is injected slowly. Some may feel a slight pressure depending on the amount of solution used, but this procedure is generally pain free.
- The patient is monitored 15-20 minutes before discharge.
Sedation may be prescribed for patients with anxiety, but this is rarely necessary since the procedure is usually pain free. A patient will be advised not to eat or drink for several hours before the procedure when a sedative is used.
Tenderness at the insertion site may occur a few hours after the procedure. This pain can easily be treated by applying an ice pack to the spot for 10-15 minutes. Patients are also advised to rest after an epidural steroid injection and resume normal activities the next day. There are cases when the pain may temporarily increase for several days after the injection. This can be caused by the pressure of the fluid injected or local chemical irritation. Therefore, it is important for patients to discuss if pain medication should be taken after the procedure with their physicians.
