Overview

For some people, the nerves that are responsible for chronic pain are in the area surrounding the spinal cord, called the epidural space. An epidural is an injection of medicine into this space to try and ease the pain. There are 2 types of medicine that are usually used. These are a local anaesthetic, and a steroid to help reduce inflammation.

Benefits of having an epidural

It might give you a temporary, or more permanent, reduction in pain. If it is successful, this treatment can help to increase your physical activity, and you might be able to reduce your pain medicines.

Each patient reacts differently, so it’s not possible to say that an epidural will definitely ease your pain.

Risks of having an epidural

Epidurals carry a small risk of side effects or complications. These include:

• a headache, which happens in 1 in every 200 cases
• a skin infection at the injection site, causing redness, swelling or discharge of pus, which happens in 1 in every 1,000 cases
• bleeding and bruising at the injection site, which is common but usually mild
• temporary numbness or weakness as a result of the local anaesthetic. This usually gets better in 2 to 3 hours and might mean you need to stay in hospital overnight (but this is rare)
• an allergy to the medicines injected, which affects 1 in every 40,000 cases
• nerve injury, such as temporary numbness or weakness, which affects 1 in every 1,000 cases. This usually gets better in days or weeks. Permanent nerve injury is so rare that it is hard to be exact, but it’s estimated to be 1 case in every 30,000 procedures.

Other treatment options

By the time you consider an epidural injection for limb pain, you should have already tried other, simpler treatments. These include oral painkillers and physiotherapy.

Medicine – Taking an unlicensed medicine

Some of the medicines we use are not licensed to be given as epidural injections. This means that the manufacturer of the medicine has not specified it can be used in this way. However, there is evidence that they work to treat this particular condition, and have been used this way worldwide.

You can read our information about unlicensed medicines. If you would like a copy, please ask your doctor, nurse or pharmacist, or call the pharmacy medicines helpline.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

On the day of the procedure

A nurse will take your blood pressure and you will be given a gown to change into. You will then be taken to the preoperative area to wait for your procedure.

The time stated for your procedure is actually the time you need to arrive by so that we can make sure that you are prepared and ready for your procedure. You might have to wait for a while in the preoperative area.

If you are having this treatment under sedation, your anaesthetist and pain specialist will see you before your procedure.

Pregnancy

If you could be pregnant, you will be asked for a urine (pee) sample, for us to test to make sure you are not pregnant. You must tell your doctor if you could be pregnant. X-rays are safe for adults, but might harm a developing baby, so are not usually done during pregnancy. If you are pregnant, your doctor will discuss alternatives to the procedure.

Medicines

It is important that you take all your medicines as usual. However, you must let us know if you take medicines that thin your blood (such as warfarin, rivaroxaban, or clopidogrel), or specific diabetes medicines (such as insulin or metformin). If you take these, or are unsure, please tell the pain team, phone: 020 7188 8877 at least 2 weeks before your procedure, to help us manage these.

During an epidural

The injection is given in a surgical setting, using X-rays to guide the needle into the correct position.

• Before the injection, a thin, flexible tube (cannula) is inserted using a needle, into a vein in your hand or arm. This is so that we can give you medicines.
• You will be lying on your front or side on the theatre table.
• Antiseptic solution is used to clean the skin on your back or neck, and a local anaesthetic injection is given to numb the skin, to minimise any pain when the epidural is given.
• The epidural needle passes through the numb skin, between the bones of your spine, and into the epidural space.
• Contrast (a dye that shows up on X-rays) is injected into the epidural space and viewed by X-ray to confirm that the needle is in the correct place.
• A mixture of local anaesthetic and steroid is then injected, and the needle is removed.

Pain during the procedure

Your doctor will be doing a procedure on a very sensitive area, so you might have some pain. You will be given local anaesthetic and, if appropriate, sedation to minimise this. If you have any concerns, you can discuss them with your doctor before the procedure.

After the procedure

You will need to stay on the unit for at least 1 hour after your procedure, so you can be monitored, and we are sure that it is safe for you to leave hospital.

Any medicine that you need to take will be explained to you, and you will be given written information about it, and any aftercare instructions, before you leave. Please ask any questions before you leave.

If possible, you should arrange for a responsible adult (over 18 years old) to drive you home or escort you in a taxi. You should not travel alone if you have had sedation.

If you have to travel alone, please use a taxi. We recommend not travelling by public transport because it is not safe if you feel unwell.

You can leave when your nurse says you are well enough, and there is a responsible adult to escort you.

After you leave hospital

After the procedure and for the rest of the day, it is important for your safety that you follow the advice below.

Please rest at home for the remainder of the day, and follow the instructions that the doctors and nurses have given you.

Although you might feel fine, your reasoning, reflexes, judgement and co-ordination skills can be affected for up to 24 hours after your procedure. During this time (or 48 hours if you have had sedation), do not:

• drive any vehicle, including a bicycle
• operate any machinery
• attempt to cook, use sharp utensils, or pour hot liquids
• drink alcohol
• smoke
• take sleeping tablets
• make any important decisions or sign any contracts

It is important to note that some people feel pain relief immediately after the procedure, but some people feel no immediate change and the pain relief starts over a few days. Some people feel worse for a short time before it improves. If you have some soreness at first, you should take your usual painkillers and rest until it settles.

Follow-up appointments

Before you leave the hospital, your follow-up appointment will be arranged. This appointment will be on the phone or in clinic, so we can assess the effectiveness of the procedure.