What is an epidural?
The term ‘epidural’ refers to the space between your spinal cord and vertebral column (spine). All nerves pass through the epidural space as they leave the spinal cord to different parts of the body.
Why do I need a cervical epidural injection?
An epidural injection is one method that is used to relieve neck and arm.
A local anaesthetic and a steroid mixture are injected into the epidural space and these bathe the nerve roots. The injection may be given as a single treatment or as a course of treatments.
It will not necessarily cure your pain, but may relieve some or all of it for a time, allowing you to increase your mobility and loosen stiff joints and muscles that have not been used for a while.
The diagram below shows the position of the needle in your back during the injection.
What happens on the day of treatment?
The procedure is carried out as a day case and hospital admission is usually for a morning or afternoon only.
On arrival, a nurse will ask you a few brief questions. You will then be asked to put on a theatre gown and your blood pressure and pulse will be recorded. A doctor, usually your Pain Consultant will then discuss the procedure with you and you will be asked to sign a consent form.
The procedure is carried out in an operating theatre. This allows for the injection to take place in a clean environment with appropriate care and monitoring.
Before entering the theatre, a small needle will be inserted into a vein in the back of your hand. This allows the doctor to give you sedation or
other medication if needed.
The injection is performed with you lying on your front or sitting up with your head bent down. The doctor will clean your neck with an antiseptic fluid, which can feel very cold on the skin.
Local anaesthetic is then given into the neck. This may sting initially, but the area will soon go numb.
A needle is then inserted between two of the bones (vertebrae) in your neck. You may feel a pushing sensation and some discomfort at this stage. The doctor may take an X-ray picture and inject some dye that will help show whether the needle is in the correct position. Once the needle is in the correct position, the local anaesthetic and steroid mixture is injected. You should let the doctor know if you feel any pain. The whole procedure usually takes around 20 minutes. A small dressing is placed over the injection site and this should be left in place for 12 hours.
Once the injection is completed, you will be taken to the recovery area within the theatre suite where your blood pressure and breathing will be monitored for a short period of time. You will remain on the trolley/bed for around 1 hour.
The local anaesthetic may work immediately and for a short period to relieve some of your pain. The steroid works by reducing inflammation and ‘over activity’ in the nerves. It may take about 2 weeks to reach its full effect.
It is important that you move normally and carry out your day to day activities as normal to see if the injection has been helpful.
You may have a bath or shower on the same day and will be able to return to all your usual activities the following day.
An exception to this is driving. If you have had sedation you should not drive for 24 hours and will need a friend or relative to go home with you.
Potential complications of epidural steroid injections
Some people experience tenderness or bruising at the injection site. This usually settles over the next few days.
As well as carrying pain messages, some of the nerves in the epidural space carry instructions to the muscles and skin in your arms. If these nerves
are numbed, your arms can become weak and feel numb. Other nerves control your heart rate and breathing. If these nerves are numbed, your blood pressure can fall and you may feel faint. If this
happens your blood pressure will be monitored more closely, but it is temporary and will pass.
Rarely during the injection the nerves in your neck may be touched by the needle. This may cause numbness or tingling in part of your arms. This is usually temporary and slowly improves over a few days or weeks.
With any type of injection there is a risk of infection. Over a few days you should observe if the area around the injection becomes painful and swollen, red, hot to touch or ‘weepy’. If this continues and especially if you feel unwell or concerned, you should contact the Pain Clinic. You may be advised to come back to hospital.
Occasionally, the layer beneath the epidural space gets punctured by the needle during the injection. This is called a ‘dural tap’ and can mean that
fluid that cushions the brain and the spinal cord leaks out which causes a headache. If this clearly happens during your injection, you will be asked to stay in hospital overnight to be given
painkillers and intravenous fluid. If a headache develops at home after your injection, it is advisable to take paracetamol, drink plenty of fluids and lay flat when possible. If it continues for
several days, please contact the Pain Clinic. You may be advised to come back to hospital.
People are often concerned about the side effects of steroids. A fairly small dose is used in the injection and most people do not experience any side effects, if you have any concerns please ask about these before you give your consent for the injection.