Epidural Blocks

CERVICAL EPIDURAL INJECTIONS

What is a Cervical Epidural Injection and why is it helpful? 

A cervical epidural injection places anti-inflammatory medication (cortisone) into the epidural space.  This is done to reduce pain in the shoulders, neck, and arms.  Your pain may be caused by nerve root inflammation and the cortisone decreases the inflammation and allows the healing process to ensue.

What is the Cervical Epidural Space? 

Your cervical spine is covered by a dura.  The space surrounding this is called the epidural space.  Nerves travel through the epidural space in route to the shoulders and arms.  These nerves may become inflamed as a result of a damaged or herniated disc.  Inflammation of these nerves can cause pain in the shoulders, neck, or arms.

How is the Procedure Performed? 

A cervical epidural injection is performed by Dr. Jagodowicz in an operating room setting as an outpatient procedure.  An intravenous line will be started so that relaxation medication can be given during the procedure.  You will be lying on your stomach on a special x-ray table.  All precautions will be taken to ensure a sterile environment during the procedure.  A local anesthetic will be used to numb the skin over the neck area.  Dr. Jagodowicz will then direct a special epidural needle, using x-ray guidance, into the epidural space.  When proper placement has been confirmed by fluoroscopy (x-ray) using a contrast dye, a combination of numbing medicine (Xylocaine) and cortisone (Kenalog) is injected into the epidural space.

Is the Procedure Painful? 

You may feel some pressure sensation as the epidural space is entered.  You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum.  Post procedure, you may experience some injection site tenderness for several days.  Cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day.

IAre there any Risks or Side effects from the Procedure?

Any time there is an injection through the skin, there is a risk of infection or bleeding.   Sterile conditions are always used for this procedure.  Although rare, nerve injury may occur.  Also rare, is a headache lasting for a few days.

Who should not have this Procedure?   

If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have the procedure.  The procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present.  If you are pregnant, you should not have this procedure.

 What are my Pre/Post Procedure Instructions?

Patients should have nothing by mouth for at least 6 hrs. prior to the procedure.  You may take your regular medication (blood pressure) with a sip of water.  You will need a ride home and you should not drive yourself for at least 8 hrs after the block. You can return to normal activities the following day.

THORACIC EPIDURAL INJECTIONS

What is a Thoracic Epidural Injection and why is it helpful?

A thoracic epidural injection places anti-inflammatory medication (cortisone) into the epidural space. This is done to reduce pain in the upper and mid back. Your pain may be caused by nerve root inflammation and the steroids decrease the inflammation and allow the healing process to ensue.

What is the Thoracic Epidural Space?

Your thoracic spine is covered by a dura. The space surrounding this is called the epidural space. Nerves travel through the epidural space in route to the upper and mid back. These nerves may become inflamed as a result of a damaged or herniated disc. Inflammation of these nerves can cause pain in your back.

How is the Procedure Performed?

A thoracic epidural is performed by Dr. Jagodowicz in an operating room setting as an outpatient. An IV will be started so that relaxation medication can be given during the procedure. You will be lying on your stomach on a x-ray table. All precautions will be taken to ensure a sterile environment during the procedure. A local anesthetic will be used to numb the skin over the back area. Dr. Jagodowicz will then direct a special epidural needle, using x-ray guidance, into the epidural space. When proper placement has been confirmed by fluoroscopy (x-ray) using a contrast dye, a combination of numbing medicine (Xylocaine) and a steroid (Kenalog) is injected into the epidural space.

Is the Procedure Painful?

You may feel some pressure sensation as the epidural space is entered. You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day.

Are there any Risks or Side effects from the Procedure?

Any time there is an injection through the skin, there is a risk of infection or bleeding. Although rare, nerve injury may occur and you may also experience a headache lasting for a few days.

Who should not have this Procedure?

If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have the procedure. The procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present. If you are pregnant, you should not have this procedure.

What are my Pre/Post Procedure Instructions?

Patients should have nothing by mouth for at least 6 hrs. prior to the procedure. You may take your regular medication (blood Pressure) with a sip of water. You will need a ride home and you should not drive yourself for at least 8 hrs after the block. You can return to normal activities the following day.

Lumbar Epidural Injections

What is a Lumbar Steroid Epidural?

lumbar_epiduralA lumbar epidural delivers a steroid into the epidural space around the spinal nerve roots that continue as nerves down your legs. This reduces the inflammation of these nerves, which is often the source of the pain. In addition to controlling pain, the process of natural healing can occur more quickly once the inflammation is reduced.  Spinal nerves can become inflamed due to irritation from a damaged disc or from contact with a bone spur.  This can result in pain and or numbness in your hip, groin, and legs.
What are the types of lumbar epidurals?

1. Translaminar Epidural: The needle is placed between the lamina of two vertebrae directly from the back. This method accesses the large epidural space overlying the spinal cord. (see diagram above)  Medication is delivered to the nerve roots of both the right and left sides of the inflamed area at the same time.   2. Transforaminal Epidural: The needle is placed to the side of the vertebra in the neural foramen, just above the opening for the nerve root. This is also called a “Selective Nerve Root Block”.  Use of a contrast dye helps to show the nerve root outline on fluoroscopy.  This method treats one side at a time and delivers a concentrated steroid solution on the nerve root directly (see diagram above).

How is the procedure performed?

lumbar_xrayA lumbar epidural is performed by Dr. Jagodowicz in an operating room setting as an outpatient.  An intravenous line is started so that relaxation medication can be given during the procedure.  You will be on your stomach on a special x-ray table.   All precautions will be taken to ensure a sterile environment during the procedure.  A local anesthetic will be used to numb the skin over the back area.  Dr. Jagodowicz will then direct a special epidural needle, using x-ray guidance, into the epidural space.  When proper placement has been confirmed by fluoroscopy (x-ray) using a contrast dye, a combination of numbing medicine (Xylocaine) and a steroid (Depo Medrol or Kenalog) is injected into the epidural space.
Is the Procedure Painful?

You may feel some pressure sensation as the epidural space is entered.  You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum.  Post procedure, you may experience some injection site tenderness for several days.  Cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day.

Are there any Risks or Side effects from the Procedure?

Any time there is an injection through the skin, there is a risk of infection or bleeding.  Although rare, nerve injury may occur and you may experience a headache lasting for a few days.

Who should not have this Procedure? 

If you are on blood thinning medication (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should not have the procedure.  The procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present.  If you are pregnant, you should not have this procedure.

What are my Pre/Post Procedure Instructions?

Patients should have nothing by mouth for at least 6 hrs. prior to the procedure.  You may take your regular medication (blood Pressure) with a sip of water.  You will need a ride home and you should not drive yourself for at least 8 hrs after the block. You can return to normal activities the following day.

Caudal Epidural Injections

What is a Caudal Epidural Injection and why is it helpful?

injection_pointA caudal epidural injection places anti-inflammatory medication (cortisone) into the epidural space at an area called the sacral hiatus. This is the epidural space located at the base of the spine. This procedure is easy to perform and decreases the risk of dural puncture. Because of the distance needed to reach the nerve roots, substantial volume of injectate is needed. This is done to reduce pain in the lower back and legs. Your pain may be caused by nerve root inflammation and the steroids decrease the inflammation and allow the healing process to ensue.

 

What is the Caudal Epidural Space?

caudal_imgYour lumbo-sacral spine is covered by a dura. The space surrounding this is called the epidural space. Nerves travel through the epidural space in route to the lower back and legs. These nerves may become inflamed as a result of a damaged or herniated disc. Inflammation of these nerves can cause pain in the low back and legs.
How is the Procedure Performed?

A caudal epidural is performed by Dr. Jagodowicz in an operating room setting as an outpatient. An IV will be started so that relaxation medication can be given during the procedure. You will be lying on your stomach on a special x-ray table. The injection area will be prepped in a sterile fashion. A local anesthetic will be used to numb the skin over the sacral area. Dr. Jagodowicz will then direct a special epidural needle, using x-ray guidance, into the caudal epidural space. When proper placement has been confirmed by fluoroscopy (x-ray) using a contrast dye, a combination of numbing medicine (Xylocaine) and a steroid (Depo Medrol) is injected into the epidural space. Is the Procedure Painful? You may feel some pressure sensation as the epidural space is entered. You will receive sedation (usually by an Anesthesiologist) during the procedure and discomfort will be kept to a minimum. Post procedure, you may experience some injection site tenderness for several days. Cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day. Please refer to the LUMBAR EPIDURAL section for risks, side effects, and who should not have this procedure done.

What are my Pre/Post Procedure Instructions?

Patients should have nothing by mouth for at least 6 hrs. prior to the procedure. You may take your regular medication (blood Pressure) with a sip of water. You will need a ride home and you should not drive yourself for at least 8 hrs after the block. You can return to normal activities the following day.