What is the epidural space?
The spine contains a covering over the nerve roots called the dura. The epidural space is the space surrounding this dura. Nerves make their way through the epidural space before they make their way down into your arms. These nerves proceed to exit the spine from tiny nerve holes. Pain may be experienced in your arms, neck or shoulder due to inflammation of these nerve roots. Inflammation of these nerve roots is caused by contact with a bone spur or due to irritation from a damaged disc.
What is an epidural injection and why is it beneficial?
Inflammation is halted in the nerve roots through the use of an epidural injection which places anti-inflammatory medicine into the epidural space, in hopes that it minimizes arm or neck or shoulder pain. The epidural injection may speed up the natural healing process. In roughly 2-3 days it will reduce pain and enhance function. This could provide everlasting relief or provide pain relief for a period of time that will allow different forms of treatment, such as physical therapy, chiropractor to be highly effective. Our physicians believe that it will reduce your pain in the duration of several months, while the injury/cause of your pain is healing.
What will happen during the injection?
The physician will ask you to lie down on an x-ray table so that they may proceed to clean your skin. Although it may sting for a little, the physician will then numb a small area of skin in the back of the neck. Through the use of fluoroscopic (x-ray) guidance, the physician will then maneuver a tiny needle into the epidural space. You will experience pressure during this part. To be sure that the medicine spreads thoroughly to the affected nerve root(s), the physician may inject a contrast dye into the epidural space. Once it has been confirmed that the medicine spread thoroughly, the physician will then continue to inject a mixture of numbing medicine and time release anti-inflammatory cortisone.
What should I do after the injection?
Once the procedure is complete, you will have to wait 30 minutes in recovery before you are to leave. Do not operate any heavy machinery for eight hours. Our physicians, Leovigildo Reyes, MD, Lawrence Eppelbaum, MD and Hamid Tehrani, MD will be able to answer your questions or symptoms after procedures by phone and expect patients to come back for follow up in one week and report the percentage of reduction of pain. The procedure does not need to be repeated if you are experiencing more than 90% pain relief. It would be helpful to come back in two weeks to repeat the procedure if you are experiencing partial pain relief. Contact our clinic in Atlanta, Georgia if you are experiencing absolutely no relief for the procedure not to be repeated. At most our clinic performs three epidurals each one-two weeks apart.
General Pre/Post Instructions
Two hours before the procedure, try to eat a light meal. Do not alter your regular food intake if you happen to be an insulin dependent diabetic. Proceed with taking your daily routine medications such as diabetes medications and high blood pressure medications. One day before the procedure, do not take aspirin and any anti-inflammatory drugs (E.G., Motrin/Ibuprofen, Relafen, Daypro, Aleve). Do not take blood thinner medications, like Xarelto, Coumadin, etc. for at least three days prior to procedure. You may continue taking these medications 24 hours after your procedure. If you are prescribed pain medicine, you may take it as needed before/after the procedure. Contact our clinic ahead of time if you are taking herapin, Plavix, Ticlid, Coumadin, or lovenox so that we may inform you of the timing of stopping these medications. We will not proceed with the procedure if you have a fever or an active infection. Contact someone reliable who may be able to drive you. 24 hours after the procedure you may once again continue with your normal daily activates, including going to work.