THE NEUROMUSCULAR AND ELECTRODIAGNOSTIC CLINIC RIVERVIEW HEALTH CENTRE Dr. Davyd Hooper, MD, FRCPC

CAUDAL EPIDURAL PATIENT INFORMATION SHEET

What is an Epidural Steroid Injection?

Epidural Steroid Injections (ESI) are typically used to reduce buttock and leg pain caused by spinal stenosis or a disc herniation. The injections work by reducing the inflammation (swelling and irritation) of the nerve roots that exit the spine. The goal is to inject the medication into the epidural space that is connected to the nerves. We do this injection under ultrasound guidance.

What medications are used?

The corticosteroid that is used is called dexamethasone. It is a medication that helps decrease the inflammation in the area of the nerve roots. Some saline (sterile salt water) is injected with it to give it some volume so the medicine can be flushed up to where the nerves are compressed.

What are the risks?

It is common to experience increased back pain/pressure and sometimes leg pain during the procedure.  This occurs because the extra fluid present increases pressure on the nerves.  Most often it is a pressure pain where we have to take a few breaks to let the pressure ease off.  Though we do the procedure under sterile conditions, there are rare cases of infection at the injection site.  A very rare complication is bleeding (hematoma) or abscess in the epidural space (where the nerves are) that could cause pressure build up on the nerves.  There have been rare cases (world wide) of paralysis resulting from this procedure. This remains a risk. This risk is higher in patients who are on blood thinners.

How is the medication administered?

You will be asked to lie on your stomach on a special bed with a pillow under your pelvis.  After you are positioned and the injection site is identified by ultrasound, the area is prepped with an antiseptic solution.  A first needle is used to inject local anesthetic (freezing) onto the ligament.  A second needle is used to access the epidural space. Once the needle is correctly placed the medication will be injected.

How will I feel after the injection?

The medication takes a few days to start having an effect. Therefore, it may be 2 to 3 days before you have any relief from your pain. If you have any soreness at the injection site you may use an ice pack for 10 minutes, two to three times a day.

Who shouldn’t have an Epidural Steroid Injection?

People who have an infection or fever, and women who are pregnant should not undergo this procedure.  This injection is meant to help “nerve pain” which is usually buttock pain that radiates down the leg with numbness and tingling.  People suffering from isolated back pain (no leg pain) are unlikely to benefit and should not undergo this injection.

For what reason should I call my doctor after the injection?

You should contact your physician if you are having any of the following:
•• Intense and prolonged headache
•• Redness or warmth at the injection site
•• Fever
•• Loss of bladder or bowel control
•• New numbness/weakness in your legs or severe back pain

What restrictions will I have after the injection?

• It is suggested that you bring a driver with you. This is for your safety.
• Avoid heating pads on the injection site and soaking in the bathtub or hot tub for the rest of the day
• Engaging in light activity for the rest of the day is suggested. 

For a good video demonstrating this technique please click here.

Please note that our injection is performed with ultrasound guidance. There is no radiation and we do not inject dye.