What is an epidural injection?
An epidural is a procedure that involves injecting a medication — either an anesthetic or a steroid — into the space around your spinal nerves known as the epidural space. The goal of an epidural procedure is to provide pain relief (analgesia) or a complete lack of feeling (anesthesia) for one region of your body, such as your legs or belly.
An epidural is commonly called the following terms:
- Epidural anesthesia
- Epidural block
- Epidural steroid injection (ESI)
- Regional anesthesia
- Neuraxial anesthesia
For pain management, an epidural steroid injection (ESI) involves an injection of a steroid or corticosteroid into your epidural space. It can help relieve neck, arm, back and leg pain caused by inflamed spinal nerves due to certain conditions or injuries. Pain relief from an ESI may last for several days or even years.
Why are epidural injections used?
Your healthcare provider may recommend an epidural procedure for the following situations:
- To provide pain relief (analgesia) for labor and childbirth.
- To provide anesthesia for certain surgeries as an alternative to general anesthesia.
- To provide pain relief after certain surgeries.
- To manage certain causes of back pain and other forms of chronic pain (through epidural steroid injections).
An epidural injects medication into the space around your spinal nerves known as the epidural space.
Who is a candidate for an epidural injection?
People who have pain in their neck, arm, lower back or leg due to the following conditions may benefit from epidural steroid injections:
- Spinal stenosis
- Herniated disk (slipped, ruptured or bulging disk)
- Degenerative disk disease
Epidural steroid injections are often used to manage or treat chronic pain. Depending on what’s causing your pain, your healthcare provider will inject the epidural somewhere along your spine. Here are the general steps of an epidural steroid injection procedure:
- You will lie on a comfortable table on your stomach or side.
- Your healthcare provider will thoroughly clean the area of your back where they’ll insert the epidural to minimize the risk of infection.
- Your provider will inject local anesthesia with a small needle near the area where they’ll insert the epidural. This is so you won’t feel as much pain when they insert the epidural needle, which is larger than a standard shot needle.
- Once the area is numb, your provider will most likely use an imaging machine, such as fluoroscopy equipment or a CT scanner (both are radiology imaging) to help guide the epidural needle to exactly the right position.
- When the epidural needle is in place in the epidural space around your spinal cord, your provider will inject the contrast material. The contrast material will make it easier for your provider to see the area they’re targeting on the screen of the imaging machine. This helps to make sure that the medication will reach the inflamed nerves they are targeting.
- Your provider will then slowly inject the medication, which is usually an anti-inflammatory medication, such as a steroid or corticosteroid. Some providers may inject a mixture of a corticosteroid and a long-acting anesthetic.
- When your provider is done with the injection they’ll clean the area again and apply a dressing to the site. You’ll move into a chair or bed to rest for a few minutes to an hour. This is so your provider can make sure you don’t have any reactions to the medication before you go home.
Risks / Complications
What are the risks or complications of getting an epidural?
Epidurals are usually safe, but there are risks of certain side effects and complications. Although rare, risks and complications that apply to all types of epidural procedures include:
- Having low blood pressure, which can make you feel lightheaded.
- Experiencing a severe headache caused by spinal fluid leakage. Less than 1% of people experience this side effect.
- Getting an infection from the epidural procedure, such as an epidural abscess, discitis, osteomyelitis or meningitis.
- Having a negative reaction to the medications, such as hot flashes or a rash.
- Experiencing bleeding if a blood vessel is accidentally damaged during the injection, which could cause a hematoma or a blood clot to form.
- Having damage to the nerves at the injection site.
- Temporarily losing control of your bladder and bowels. You might need a catheter (a small tube) in your bladder to help you pee.
Disadvantages and risks that apply to epidural analgesia for labor and delivery specifically include:
- You might lose feeling in your legs for a few hours.
- It might slow down the second stage of labor.
- You might not be able to push and need help to give birth. Your provider may need to use forceps or a vacuum to help deliver your baby.
- Your baby will need to be closely monitored during your labor.
Risks and complications that apply to epidural steroid injections specifically include:
- Experiencing a temporary increase in pain.
- If your provider uses fluoroscopy or a CT scan for imaging guidance, there will be minimal low-level radiation exposure due to the X-rays.
- If you have diabetes, a steroid injection will likely cause high blood sugar (hyperglycemia). This could last for several hours or even days.
Frequently Asked Questions
Can getting an epidural cause back problems?
There’s a common belief that getting an epidural will lead to back pain, but it’s very rare for an epidural to cause long-term or chronic back problems.
It’s normal to experience temporary back pain or tenderness at the site of your epidural. This usually goes away within a few days.
This belief likely stems from the fact that many people who go through childbirth experience back pain after labor and delivery — whether they’ve had an epidural or not. This is because the bones and ligaments in your pelvis are shifting back into their original positions from before your pregnancy, which can cause back pain and discomfort.