What is a Thoracic Epidural Injection?
What is the epidural space?
The membrane that covers the spinal cord and nerve roots in your spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to your mid back and along the ribs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contact in some way with the bony structure of the spine.
What is an epidural and why is it helpful?
An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in your mid back or around your rib cage. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury or cause of your pain is healing.
What will happen to me during the procedure?
An IV will be started so that relaxation medication can be given. You will be placed lying on your stomach and positioned in such a way that your doctor can best visualize your upper back using X-ray guidance. The skin on your upper back will be scrubbed with a cleaning solution. Next, the physician will numb a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, your doctor will direct a small needle using X-ray guidance into the epidural space. A small amount of contrast (dye) is then injected to ensure proper needle position in the epidural space. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.
What will happen after the procedure?
You will go back to the recovery area, where you will be monitored for 30 – 60 minutes. You will then record the relief you experience during the next week on a post-injection evaluation sheet (“pain diary”). This will be given to you when you are released to go home. You will also be given a follow-up appointment for a repeat block if indicated. You will not be able to drive the day of your procedure. Your back may feel weak or numb for a few hours.
General Pre/Post Instructions
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.