Thoracic Epidural Injection

What is the epidural space?
The membrane that covers the spine and nerve roots 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 contact 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?
The patient is placed lying on their abdomen on the xray 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 cleansed using a solution called Betadine. Next, the physician injects 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 proper needle position 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 transferred to the recovery area where they are monitored for 30 minutes. Patients are then asked to report the relief they experience during the next week by calling the clinic. A follow-up appointment will be made. A repeat block may need to be scheduled if indicated. The back or legs may feel weak or numb for a few hours. This is not unusual, but does not always happen.

General Pre/Post Instructions
Patients may eat a light meal before the procedure. If a patient is an insulin dependent diabetic, they should take their insulin and eat.

Patients may take their routine medications. (i.e. high blood pressure and oral diabetic medications). If a patient is on Coumadin, Lovenox, or Plavix (blood thinners) they must notify the office so that special instructions may be given.

If you are allergic to iodine, contrast, or medical dye, please inform the office. Patients can expect to be at that facility approximately 1½.

A driver must accompany the patient and be responsible for getting them home. It is best if no driving is done the day of the procedure and after the injection. Patients may return to their normal activities the day after the procedure, including returning to work unless otherwise instructed by the physician.