Thoracic Epidural Injection
What is the epidural space?
The membrane that covers the nerve roots is called the dural membrane.
The space surrounding the dura is the epidural space. Nerves travel
through the epidural space before they form the nerves that travel along
your ribs. Inflammation of these nerve roots may cause pain in your
mid-back, along your ribs, to your chest wall or abdomen. These nerve
roots may become inflamed and painful due to irritation, for example,
from a damaged disc or from contact with the bone.
What is an epidural injection and why is it helpful?
An epidural injection places anti-inflammatory medicine into the epidural
space to stop inflammation of the nerve roots, therefore hopefully reducing
mid-back and chest wall pain. By stopping or limiting nerve root inflammation
we may be able to reduce your pain. The epidural injection may assist
the injury to heal by reducing inflammation. Although not always helpful
it usually reduces pain and improves function in the majority of cases
within 3-7 days. It may provide permanent relief or provide a period
of pain relief that will allow other treatments like physical therapy
to be more effective. We hope it will reduce your pain during the next
several months while the injury/cause of your pain is healing.
What will happen to me during the procedure?
First an IV is started so that you may be given medicine for relaxation
if you so desire. Next, while lying on your stomach, the skin over your
mid-back will be well cleaned. The physician will numb a small area
of skin which may sting for a few seconds. Next, the physician will
use x-ray guidance to direct a small needle into the epidural space.
He will then inject contrast dye to confirm that the medicine spreads
to the affected nerve root(s) in the epidural space. After this, the
physician will inject a combination of numbing medicine and time release
anti-inflammatory cortisone.
What should I do after the procedure?
You will wait 30-60 minutes in recovery before going home. You should
not drive for eight hours following this procedure. Please record your
pain relief during the next week on a "pain diary" we will provide to
you. Mail the completed pain diary back to Tyler Nuerological Associates.
If you experience complete relief or more than 90% relief we will not
repeat the procedure. If you experience partial relief it may be beneficial
to repeat the procedure in about two weeks. If you experience no relief,
notify the office and the procedure will probably not be repeated. We
perform a maximum of three epidurals each 2 weeks apart.
General Pre/Post Instructions
You should eat a light, but not a full meal at least 2 hours before
the procedure. If you are an insulin dependent diabetic do not alter
your normal food intake. Take your routine medications before the procedure
(such as high blood pressure and diabetes medications). Stop aspirin
and all anti-inflammatory medications (e.g. Motrin/Ibuprofen, Aleve,
Relafen, Daypro) 3 days before the procedure. These medicines may be
re-started the day after the procedure. You may take your regular pain
medicine as needed before/after the procedure. If you are on coumadin,
heparin, lovenex, plavix or ticlid you must notify our office so that
the timing of stopping these medications can be explained. If you are
on antibiotics please notify our office, we may wait to do the procedure.
If you have an active infection or fever we will not do the procedure.
You will be in the hospital as an out-patient for 2-3 hours even though
you see the physician for 20 minutes. You will need to bring a driver
with you. You may return to your current level of activities the next
day including return to work.
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