Epidural Steroid Injections/Selective Nerve Blocks

DEFINITION: An epidural steroid injection is a treatment modality geared toward reducing pain and swelling, as well as helping to diagnose a spinal disorder. With the help of a special x-ray machine, a fluoroscope, a doctor is able to accurately perform the desired injection. The active ingredient for the majority of these injections is a type of corticosteroid called Depo-Medrol. Lidocaine is a local anesthetic that is used to anesthetize the skin and tissues under the skin to minimize any discomfort from the procedure. Marcaine is the long acting anesthetic used for performing the nerve block, and is often times used for a variety of other injections performed such as a facet block or a hip joint injection, both of which are performed with fluoroscopic guidance.

Other procedures performed under x-ray guidance include facet injections, sacroiliac joint injections, hip injections and certain types of trigger point injections.

MECHANISM OF ACTION: Epidural steroid injections and nerve blocks work in a variety of ways. The primary method of action is the reduction of nerve and soft tissue inflammation and swelling. The common diagnoses that are treated via this approach include disc herniation, arthritis of the spine, spinal stenosis, disc degeneration, sacroiliitis, hip arthritis, labral tear of the hip and a pinched nerve.

BASICS: Prior to having the procedure performed, it is important to notify the scheduler and/or nurse if you are taking a blood thinner such as Coumadin or Plavix. Often times, you will be asked to be off of this type of medication for at least six to seven days prior to being able to have this type of procedure performed. There may be some rare exceptions to this so you certainly need to make us aware. The patient’s comfort is of utmost importance when this type of procedure is performed. Every step is taken to minimize discomfort and anxiety.

PREPARATION: Regarding anti-inflammatory medications such as ibuprofen, naproxen, and aspirin, you will typically need to be off of this class of medication for five days prior to having the injection performed. Again, you need to notify the office if you had taken this type of medication within the last five days so that the doctor performing the procedure can decide whether or not it would be safe to have it performed. Please be aware that Aleve is the same chemical compound as naproxen and Advil is the same chemical compound as ibuprofen. Once you have had the procedure performed, you will be able to resume either your blood thinner or your anti-inflammatory medication the following day. We recommend you talk to your prescribing doctor to find out if it is safe for you to stop taking the Coumadin or Plavix for a certain amount of time. You will not be required to fast prior to the procedure. Typically, you will not need someone to drive you to the office unless specified by the doctor. Often times, a driver is important if you will be having a nerve block performed involving the lower back.

AFTER CARE: It is not unusual to have soreness at the site of the injection; applying a cold compress to the site is very helpful to reduce local discomfort. Again, you may resume your blood thinner or anti-inflammatory medication the day after the procedure. If there is discomfort during the day of the procedure, Tylenol would be safe to take unless otherwise specified. The slight weakness and numbness that can occur after a nerve block will typically resolve within four to six hours. We recommend you call the doctor back within five to seven days after the procedure is performed in order to determine your response and to make further plans regarding your treatment.