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Thoracic Epidural Injection

Thoracic Epidural Injection 2017-08-08T13:42:32+00:00

There is a fluid-filled sac that covers the spine cord called the dura. The space that surrounds the dura is called the epidural space, and it is filled with fat and small blood vessels. When the nerves that travel along this space become irritated, it can be painful. This irritation can occur when the discs that normally cushion the spine are damaged or they rub up against the bony structure of the spine.

 

It is an injection of an anti-inflammatory steroid medication and local anesthetic deposited into this space in the mid-back region. The steroid shrinks swelling around the nerve roots and the local anesthetic numbs the inflamed areas and relaxes the muscles around the epidural space. To ensure proper placement of the medication, the procedure may be performed under x-ray.

 

To treat mid-back, chest, and abdominal pain that may be due to inflammation of the vertebral disc and / or nerves. However, it will not correct the medical problem causing the inflammation but may improve the level of pain you are experiencing. It is not unusual to need more than one injection to obtain long term benefit. These injections are done in a series of three, usually a month apart if needed.

 

The main risk that may occur is a dural puncture, which is higher in patients who have had previous back surgery.  It occurs when the needle is unintentionally advanced beyond the epidural space and punctures the dural sac. You may experience a severe headache that lasts for several days. If the headache does not resolve after 48 hours, a procedure known as a blood patch may be recommended.  Other risks, although remote include:  bleeding, infection, nerve injury, and allergic reaction to the medication(s). Diabetics may have short-term elevation of blood sugars.  People prone to fluid retention may have increased fluid retention for 1 – 2 weeks.

 

During the injection, your mid-back, chest, and abdominal pain may be increased temporarily.  Immediately after the injection, you may feel your mid-back slightly heavier and it may be numb, which may last 1 – 2 hours.  You may get 4-6 hours of mid-back, chest, and abdominal pain relief immediately after the injection, however your pain will return and you may have more pain than usual for 5-6 days afterwards.

 

Upon registering at Southwest Ohio Pain Center, we will begin your procedure.  If we are using x-ray, an IV will be started and you may be given medication for relaxation if you so desire.  Your mid-back will be cleansed with an anti-septic solution and numbed with anesthetic. This is felt as a stinging / burning sensation. The doctor will insert the needle into the epidural space.  This is felt as pressure, however you may also experience some increased discomfort.  Additional anesthetic will be used if this occurs. The procedure takes about 15-30 minutes. A bandage will be applied at the needle insertion site, which may be removed the next morning. You will be discharged when the physician authorizes.

 

Relief varies from one person to the next.  The only way to know is to have the injection performed.  The steroid may take several days to work and peaks in about 2 weeks.  Therefore, it may be several weeks before you feel a change in your pain.  You may apply ice to the affected area for 20 minutes every 2 hours to decrease local tenderness.  After the first day, you can perform activities as before & return to work.

You may NOT drive for the remainder of the day after your procedure.  No heat is to be used on the injection area for the remainder of the day.  No tub bath or soaking in water (pools / Jacuzzi, etc ) for the remainder of the day.

 

If you experience severe mid-back, chest, and abdominal pain, new numbness or weakness, or have signs of infection (temperature greater than 100.9°, drainage, redness / heat at insertion site ) – call IMMEDIATELY.

ON THE DAY OF YOUR PROCEDURE, PLEASE DO THE FOLLOWING:

♦ Take all blood pressure pills & heart medications prior to the procedure with a sip of water at least 3 hours before your requested arrival time. Your vitals must be stable to have the procedure.

♦ Have a responsible person to take you home.

♦ Arrive at the requested procedure time.  Please do not be late or your procedure may be cancelled. 

ON THE DAY OF YOUR PROCEDURE: 

♦ Do not take ANY of the following 5 days before your procedure:  Coumadin

♦ Do not take ANY of the following 7 days before your procedure:  Plavix

♦ Coumadin must be stopped prior to the injection. You must have a normal INR prior to the injection.  Do not stop the drug by yourself.

♦ Eat or drink 6 hours before the procedure.

NOTE:  YOUR PROCEDURE WILL BE CANCELLED IF
: 

  • You have an active infection, flu, cold, fever, or very high blood pressure.
  • You do not have a responsible driver to take you home, arrive late for your procedure, or unable to follow the medication / fluid restrictions.

Call the office at (513) 860-1039 for procedure related questions.