Epidural Injections

 

Epidural injection is a pain treatment used to relieve pain caused by nerve compression and stimulation in the neck, arm, waist and leg areas. It is used to control pain in cases such as lumbar and neck hernia, lumbar slippage and spinal canal narrowing. With the epidural injection, a drug mixture containing a long-lasting depot steroid and a local anesthetic is applied around the damaged spinal nerve through the epidural space to provide relief in the early period and prevent recurrence.

Although the effect of epidural injection application varies from patient to patient, interventions made within the first six 5% improvement in patients with new symptoms and do not require further treatment; In later cases, 60-75% months after the onset of the problem provide 90-9 of patients provide relief for 2 months to 1.5 years or more.

The purpose of the epidural injection is to relieve the pain and enable the patient to return to their normal life quickly.

 

Who can apply an epidural injection?

 

Patients with neck, arm, low back and leg pain may benefit from an epidural injection. The initiative is particularly useful in the following situations:

1. Lumbar and neck hernia - Patients in whom the gel-like inner core of the intervertebral disc herniates out of the disc and presses on the lumbar-neck nerves.

2. Low back slip - Patients with pain due to fracture, weakness and slippage between the lower and upper joints of the spine.

3. Narrow spinal canal - Patients who have pain, especially with walking, due to nerve compression in the spinal canal and spinal nerve canal.

 

Who applies an epidural injection?

 

Epidural steroid injection is performed under completely sterile and aseptic conditions in operating room conditions by anesthesiologists who have received pain management training, who are capable of performing epidural and transforaminal interventions under the control of C-arm fluoroscopy and performing all medical follow-up.

 

What should be done before epidural injection?

 

If you have flu, sinusitis or a similar infection that started on the day of the intervention or started before, or if you have a high fever even if the cause has not been determined, be sure to inform your doctor before the intervention.

Blood thinners such as Aspirin® , Coraspin® and Tebokan® , Bilokan® type drugs containing gingko biloba should be discontinued 5 days in advance.

Anticoagulant drugs (Coumadin®, Plavix®) used in special cases should also be discontinued at least 1 week in advance, after you consult the physician who recommended you to use these drugs and get the physician's approval.

Being completely hungry and dehydrated from 5 hours before the intervention; you must not have taken any solid-liquid food, water and tea. If you have a heart, diabetes or blood pressure medication that you need to use continuously, talk to your doctor and ask how you should take the medicines. 

 

How is an epidural injection done?

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The purpose of the epidural steroid injection is to deliver the drug to the closest point to the area causing the pain. The procedure is performed completely sterile and aseptically in the operating room and operating conditions, under continuous monitoring with fluoroscopy. There is no need for general anesthesia, that is, for the patient to be put to sleep with narcosis during the procedure. The application takes approximately 10-20 minutes. takes.

 

What happens after an epidural injection procedure?

 

The patient is rested in the recovery room for 1-3 hours. After the injection, there may be pain in the waist and temporary numbness and pain in the leg where the intervention was made. The pain that decreases or goes away after the intervention may start again within 4-6 hours. This is due to the fact that the effect of the local anesthetic has disappeared. The main effect of the long-acting steroid reaches the desired level within 24-48 hours and the patient's pain begins to disappear within 12-24 hours.

Rest is recommended on the day of the procedure. After 1 week the patient comes for control. If necessary, the intervention can be repeated.

 

What are the results in epidural injection?

 

A positive response is obtained in 70-90% of the patients whose complaints started within months and who were intervened in the early period; In an important part, the complaints can be completely gone. Depending on the patient's response, the intervention can be repeated after 2 weeks, but more than 2 injections in 1 month are not recommended. In patients, well-being can be achieved for a period of 6 months to 2 years or more.

Much more satisfactory and long-lasting results are obtained in patients who protect their waist and neck and perform exercise and physical therapy movements after the intervention.

 

Who is not appliede an epidural injection?

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1. No intervention is made for the patients described below;

2. Having active infection during the intervention period,

3. Pregnant or likely to be,

4. Bleeding, coagulation disorder,

5. Having an infection in the intervention area,

6. Patients who do not accept the intervention are not treated.

 

What are the risks of epidural injection?

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1. In patients with diabetes mellitus, deterioration in the sugar pattern may be observed for 1-2 weeks, and additional medication may rarely be required.

2. According to the literature, there is a possibility of infection with a frequency of 40-60 thousand patients among patients who received epidural steroid injection, but this probability is minimized by performing the procedure in the operating room under absolutely sterile conditions and by taking additional precautions.

3. Very rarely, temporary headaches may occur. Nerve damage is also very rare.

4. Depending on the steroid used, there may be fluid retention in the body. In the first week, this situation can be prevented with a salt-free diet as much as possible.