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Spinal Injections

What is a nerve root block?

                                          

A nerve root block is an injection of local anaesthetic and a steroid around one of the nerves in your spine. The local anaesthetic will numb the nerve immediately. The steroid is used to reduce inflammation and give long-term pain relief. You will generally feel the effects of the steroid about three days after the injection.                                             

X-rays are usually used during the procedure to help guide the injection to the correct nerve. A skilled technician (a radiographer) will operate the X-ray equipment and a doctor, with extra training in X-ray techniques, will usually inject the local anaesthetic and steroid.

                      

 

 

Why have nerve root block injections?

The aim of the injection is to help pinpoint which nerve, if any, is causing your back or leg pain, so your doctor can plan the appropriate treatment.

A nerve root block numbs your nerve root temporarily. If your pain improves after the treatment, the nerve blocked by the injection is the most likely cause of your pain. If your pain stays the same, then that nerve is most likely not causing your pain. A nerve root block can help with pain but it is not a cure.

Nerve root block injections are routinely done as  a day case  procedure in the theatre room or in the radiology department.

Preparing for your treatment

You won't usually need to make any preparations before the procedure.

You may be asked not to take your usual pain relief medication on the day of your procedure. This is because you need to feel and report any pain during the treatment. If you are unsure about taking your medication, please contact your doctor.

When you arrive for your treatment, you may be asked some questions about your health, experience of surgery, allergies and the medicines you are taking. You may have your heart rate and blood pressure checked.

If you have diabetes, please tell your doctor before the treatment starts. It's possible the steroid in the injection may affect your blood sugar levels.

If you are a woman of childbearing age, you will be asked if you are pregnant. A nerve root block with X-ray guidance is not recommended for pregnant women. Please tell your doctor if you could be pregnant.

You may be asked to sign a consent form. This confirms that you understand the risk, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

The procedure usually takes about 20 minutes. You may be asked to change into a hospital gown that opens at the back.You will be taken to the theatre or X-ray room and asked to lie face down on the X-ray table. The table will be positioned under the X-ray machine.

A sterile antiseptic spray or wipe is used to clean the area over the injection site. Local anaesthetic is then injected into the skin so that you don't feel the needle going into your back.

A thin hollow needle is then carefully inserted into your back. You won't feel the needle going in. However, once the needle has reached your spine it can feel uncomfortable. If you feel any pain in your leg whilst the needle is being inserted, please tell your doctor.

Once the needle is in place, your doctor will inject contrast dye (a liquid that shows up on X-ray) and take X-ray pictures. This is to ensure the needle is correctly placed close to the nerve root. Finally, local anaesthetic and steroids are injected into the nerve root.

Afterwards, your doctor will remove the needle and may cover the injection site with a plaster.

What to expect afterwards

Your doctor will help you to get up slowly from the X-ray table. Your back or legs may feel a bit stiff. You may feel a little faint or dizzy when you sit up.

When you feel ready, you will be able to go home. You will need someone to drive you home.

You may given a form to take with you. You will be asked to use the form to record your pain levels over a few days and then bring it with you on the follow up appointment.

The pain relief may last a couple weeks to a few months. If the treatment has helped with your pain, you may be able to have it again.

Recovering from your injection

You should not drive for at least 24 hours and you must follow your doctor's advice about returning to work and resuming normal activities.

Keeping mobile and gentle walking will help reduce any stiffness in your back and legs. Please contact the hospital or your GP immediately if you develop a high temperature after the procedure.

What are the risks?

Nerve root block is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

You will be exposed to some X-ray radiation during the test. Pregnant women are advised not to have a nerve root block with X-rays.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure. After having a nerve root block injection, your back or legs may feel stiff or numb for a few hours. The injection area may feel sore. You may also get a headache for a short while.

The pain in your back or legs may actually get temporarily worse, before it begins to get better.

The steroid in the injection may affect your blood sugar levels. If you are diabetic, you must closely monitor your blood sugar levels after the procedure.

Complications

This is when problems occur during or after the procedure. Most people are not affected. A possible complication of any injection around the nerve root is that the treatment reaches further than intended and goes to the spinal cord. This can cause a drop in your blood pressure or widespread numbness. Your doctor will monitor you constantly and will provide appropriate care if this happens. Sometimes it is technically difficult to perform such operation.

The main complications specific to having a nerve root injection are listed here.

· Bleeding. There are many blood vessels around the spinal cord and there is a risk the needle may puncture one. This may require further surgery.

· Infection. This is uncommon because your skin will be cleaned before the sterile needle is inserted. But if you get a high temperature, contact the hospital immediately.

· It's possible to have an allergic reaction to the steroid. If you feel itchy or have difficulty in breathing, tell your doctor immediately. Medicines are available to treat an allergic reaction.

 

Why have an epidural injection?

Epidural injections can help provide short-term pain relief for people with chronic back pain or sciatica (shooting pain down one or both legs). It involves injecting local anaesthetic and steroids into the epidural space that surrounds the spinal cord. Local anaesthetic drugs numb the spinal cord nerves instantly and the steroid helps by reducing swelling (inflammation).

It can take up to a week for the full benefits of an epidural injection to be felt. The effects of a successful injection can last anything from a few weeks to several months. If the injection helps reduce pain, it can be repeated every two months until the injury or cause of pain has healed.

                                       

What happens before an epidural?

Your doctor will discuss how to prepare for your treatment.

The procedure is routinely done as an out-patient or day case. You will stay awake during the procedure, but you may be offered a sedative to help you relax. Typically, you must not eat or drink for six hours before sedation. However, you may be allowed occasional sips of water until two hours beforehand.

You may be asked not to take your usual pain relief medication on the day of your procedure. This is because you need to feel and report any pain during the treatment. If you are unsure about taking your medication, please contact your doctor.

What happens at the hospital?

Your doctor will speak to you about the treatment and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

If you are diabetic, please tell your doctor before the treatment starts. It's possible the steroids may affect your blood sugar levels.

Generally the injection is given in the lower back. Your doctor will use X-rays and contrast media to help guide the needle into the epidural space.

If you're pregnant

Please tell your doctor if you could be pregnant. Although the radiation dose being used is generally thought to be safe for adults, it may harm a developing fetus. So, X-rays are not usually done on pregnant women. If you are pregnant, your doctor will discuss alternatives to the procedure.

The procedure

The procedure usually takes 10 to 20 minutes.

You may be asked to change into a hospital gown that opens at the back.

You will be helped onto an X-ray table and asked to lie face down.

If you are having sedatives, these will be injected into a vein in the back of your hand. You will quickly feel relaxed and drowsy.

Your doctor will carefully select a point to inject by feeling for specific bones in the spine.

A small amount of local anaesthetic is injected into the skin. After a minute or so, when the skin is numb, the anaesthetist will insert the larger epidural needle through the skin and towards the epidural space.

At this point, your doctor may take X-ray pictures to help guide the needle into the correct spot. You may find the procedure uncomfortable because the needle is being put into an area that is already painful.

When the needle reaches the correct spot, the anaesthetic and/or steroids are injected directly into the epidural space through the tube. When the treatment is complete, the tube is taken out and the area covered with a plaster.

While the doctor is preparing your back for the injection and especially whilst the epidural needle is being inserted, it is very important to stay still, as any movement makes positioning the needle more difficult.

After the epidural

Your blood pressure may be monitored for 15 to 20 minutes. When you feel ready, you will be able to go home. You will need someone to drive you home.

Before you go home, you will be informed about a date for a follow-up appointment. This is usually four to six weeks later.

After your return home

If you had sedation you should have someone stay with you for the first 24 hours. Sedatives can temporarily affect your co-ordination and reasoning skills, so you should not drive, drink alcohol, operate machinery or sign legal documents for at least 24 hours after your procedure. If you are in doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your doctor's advice.

You should take it easy for 48 hours after the injection. Try to keep active by doing some gentle walking. This can help reduce stiffness and discomfort. Follow your doctor's advice about returning to work.

What are the risks?

An epidural for chronic back pain is a commonly performed and generally a safe procedure. However, in order to make an informed decision and give your consent you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. These can include the following.

· A drop in blood pressure - after the epidural drug is given, you will have your blood pressure monitored for about 20 minutes. If your blood pressure falls, then it may be necessary to give drugs and more fluids through a drip.

· A drop in blood sugar levels - if you have diabetes, your doctor will check your sugar levels after the epidural, but you must also keep a close check on sugar levels when you go home.

· Loss of leg strength or control of the leg muscles - this wears off with the anaesthetic.

· The injection area may feel sore.

· Back or leg pain may actually get worse, before it begins to get better.

Complications are when problems occur during or after the procedure. Most people are not affected. The main complications specific to epidural injections are listed here.

· Headache - if the epidural needle nicks the covering of the spinal cord, there may be a small leak of fluid from around the cord, which can cause a severe headache lasting for up to a week.

· Bleeding - there are many blood vessels around the spinal cord and occasionally one will be pricked as the epidural needle goes in. This requires careful observation in hospital.

· Infection - this is uncommon because the skin is cleaned before the (sterile) needle is inserted. However, if there is an infection, drainage of the infected area and antibiotics may be necessary.

· Long-term numbness - some people have patches of numbness lasting up to three months. Permanent damage, such as paralysis (complete loss of sensation and movement) is very rare.

· Allergic reaction - it's possible to have an allergic reaction to the drugs or the contrast dye. If you feel itchy or have difficulty in breathing tell your doctor immediately. Medicines are available to treat any allergic reaction.

· No effect - it's important to realise that epidural injections do not work for every person. Some people may find their back pain does not improve.

You should ask your doctor to explain how these risks apply to you. The exact risks will differ for every person. This is one of the reasons why we have not included statistics here.