Epidural Injections For Non Acute Pain Patient information Leaflet January 2017 Please read this leaflet carefully. If you do not follow these instructions your procedure may be cancelled.
What Is An Epidural Injection? The epidural space is located around the outer covering of the spinal cord which runs from the base of the skull to the bottom of the spine. Nerve fibres which relay messages such as sensation and pain to the brain from the rest of the body pass through this space. Your epidural injection may involve a mixture of local anaesthetic and steroid solution that is injected into the epidural space. Your procedure may be performed under X Ray guidance. If you are female please ensure there is no risk of you being pregnant on the day of your procedure. Please contact the Pain Nurse if you have any concerns. Why is it performed? Epidural injections can be performed for patients complaining of pains in their legs, back and neck including inflammation of the nerves. However, they are mainly used to relieve pain running from the back down the legs and are not as effective when the pain affects only the back. They are also used to help with arm pain origination from the neck. The injection helps to reduce pain temporarily, by stopping the pain messages from reaching the brain and reducing inflammation. The benefit is likely to be temporary unless you perform a long term program of graduated pain free exercises. The steroid medication used should not be confused with anabolic steroids which are taken by athletes to build up muscle mass. Unfortunately no company in the UK actually produces a steroid specifically designed for the epidural space (licensed). However using standard precautions epidurally administered steroid injections have been used since the early 1970 s and are considered to be very safe by national and international pain organisations. Following your epidural injection you should perform long term regular pain free exercises as this is the best way to improve and maintain the function of your back or neck. What Are The Benefits? Temporary relief of pain, however the longer the symptoms have been present, the less successful the outcome unless accompanied by a pain free exercise program. Prevention of recurrence, if a graduated pain free exercise program is followed. Improved mobility Aid in diagnosis Are there any alternatives? By the time that you consider having epidural injection you should have already tried other more simple treatments. These include a graduated pain free exercise program, painkilling and anti-inflammatory tablets, physiotherapy and TENS. Epidural injections for Non Acute Pain Patient Information Leaflet Page 2 of 9
What are the possible side effects/complications of the procedure? All procedures in medicine carry a risk of complications. Precautions are always taken to minimize the risk as far as possible. Generally epidural injections are safe but occasionally the following risks may occur: Failure of the procedure to reduce pain Failure to perform the epidural- about 5 in 100 epidurals fail to go into the spine successfully. Worsening of pain (temporarily or permanently) Bleeding into the injection area and nearby structures Infections in the injected area Allergic reactions Numbness for back epidurals this is usually from the waist down. The numbness varies from slight to complete. If it is excessive, you will be advised to stay in hospital overnight. Hypotension (A drop in blood pressure). Inability to pass urine Severe headache (affects 1 in 100 people) - The headache is very severe and continuous. If it fails to improve with fluids and pain relieving medicine, then an epidural blood patch is performed. In this procedure, a small amount of blood is taken from your forearm, and injected into your epidural space to relieve the symptoms. Nerve damage (affects 1 in 10,000) a rare side effect. Injection into a vein or artery with toxic reaction ( very rare) Potential side effects with using steroids There are few side effects associated with either single or occasional use of steroids. These include hot flushes, feeling sick, mild abdominal pain, fluid retention, raised blood sugars in diabetics and occasionally menstrual irregularities. These symptoms should settle in a few days. If you take water tablets (Diuretics) on a regular basis then please take an extra water tablet the day after your procedure. If you are diabetic you should closely observe your diabetic control for the next fortnight. Repeated and frequent use of steroids has the potential to lead to more serious effects but the doses of steroids given in the injections are small when compared with the doses of steroids taken by mouth on regular basis. Epidural injections for Non Acute Pain Patient Information Leaflet Page 3 of 9
Prior to admission You must inform the Non Acute Pain Team at least 1 week prior to your procedure: 1. If you are allergic to local anaesthetic or steroid medication. 2. If you are or think you may be pregnant. 3. If you have an infection near the site of the injection or elsewhere. 4. If you are taking antibiotics or drugs used to treat other infections e.g. Tamiflu or have finished a course within the three weeks prior to your procedure date. 5. If you are taking blood thinning drugs such as: Warfarin, Sinthrome, Aspirin, Clopidogrel, Ticlopidinem, as it may be necessary to stop taking these medications prior to your procedure. 6. If you are experiencing any difficulty or frequency in passing urine. 7. If you have had a vaccination (including the Flu Vaccine) or are planning to have a vaccination within one month of your appointment. 8. If you have had a heart attack within the last twelve months. 9. If you have undergone surgery or had an illness within the last four weeks. 10. If you do not have anyone to collect you and stay with you for 24 hours following discharge on the day of your procedure. Please note: If you are diabetic, please ensure that your HBA1C level has been checked within three months of your procedure date and you obtain a copy of the result, as the Pain Nurse will ask for this reading prior to confirming your procedure appointment. Please do not drive yourself to the hospital as you will not be able to drive home following your procedure. You must arrange for a responsible adult to collect you and take you home by car or taxi, and they must be able to stay with you overnight. If this is not possible your procedure may have to be postponed. How long will I be in hospital for? The procedure is performed as a day-case the time detailed on your appointment letter relates to your admission time your procedure will be carried out later that morning/afternoon. Please be prepared to stay approximately half a day, although you should bring your dressing gown, slippers and current medication with you in the event that you are required to stay in hospital overnight. Epidural injections for Non Acute Pain Patient Information Leaflet Page 4 of 9
On the day of your procedure Before Admission Please follow the starving instructions below: The day before your procedure: You should eat normally, but avoid large fatty meals NO alcohol for 24 hours before your procedure Fasting on the day of your procedure: Morning Procedure NO food after 2.30am, no chewing gum or boiled sweets after 2.30am NO smoking on the day of your admission You may have clear fluids (water, weak juice, black tea/coffee NO milk or milk products) up to 6am on the morning of your operation/procedure. Nothing by mouth after 6.30am on the day of procedure. Afternoon Procedure You may have a light breakfast (such as toast or continental breakfast, or a small bowl of cereal). NO food after 7.30am. You may have clear fluids (water, weak juice, black tea/coffee NO milk or milk products) up to 11.30am. Nothing by mouth after 11.30am on the day of procedure. Evening Procedure You may a eat light breakfast and light lunch up to 12.00 noon. NO food after 12.00 noon. You may have clear fluids (water, weak juice, black tea/coffee NO milk or milk products) up to 3.00pm. Nothing by mouth after 3.00pm on the day of procedure. If you are unwell on the day of your procedure please contact: The Non Acute Pain Secretary on 0161-922-6816 OR The Daycase unit on: 0161-922-6219 Epidural injections for Non Acute Pain Patient Information Leaflet Page 5 of 9
What will happen to me before the procedure? On arrival to the unit, you will be asked to complete a pre-admission questionnaire, before being admitted by a nurse. During your admission the nurse will discuss the information provided in the questionnaire and record your pulse, blood pressure, respiratory rate, temperature and oxygen saturation (amount of oxygen in your blood), you may also be asked to provide a urine sample. If the information provided highlights a cause for concern or your observations are abnormal your procedure may be cancelled pending further investigation and treatment. Following admission you will be asked to return to the waiting area until your procedure time. Once you are called, the doctor will explain the procedure to you, and give you the opportunity to ask any questions. If you agree to have the procedure you will be asked to sign a consent form and and may be required to put on a gown. What will happen to me during the procedure? You may have a small plastic tube inserted into your vein in your hand which is connected to a drip of intravenous fluid. During the procedure you will be asked to sit or lie on your side with your back curved like the letter C. After cleaning the skin the doctor will numb the area with a local anaesthetic injection before inserting the epidural needle. During this time you may feel some pressure, this is normal. If however you experience pins and needles down your legs or arms, please let the doctor know. Once the needle is in the correct place, the injection is given slowly over 1-2 minutes. The whole procedure normally takes 15-20 minutes, your blood pressure and pulse will be checked regularly during the procedure. What will happen to me after the procedure? You may feel numbness not only at the injection site but also in your legs which may also feel weak after the procedure, this is to be expected and will usually settle within a few hours. You should therefore seek assistance from the nursing staff when first standing or walking. Occasionally you may experience prolonged weakness/ numbness in your legs or difficulty passing water which will require you to stay in hospital overnight. Following your procedure your observations will be recorded for 30 minutes and if they are stable,and you are able to pass water and mobilise safely you will be able to go home. You may have a dressing to the injection site, this can be removed after 24 hours. Please ensure you follow the instructions you are given about rest, exercise and how long to stay off work. Discharge Arrangements It is important that someone comes to collect you, and you do not attempt to drive yourself home. If you do not have anyone to escort you home, then you must discuss this with the pain team before the day of your procedure or your procedure will be cancelled. Epidural injections for Non Acute Pain Patient Information Leaflet Page 6 of 9
Once at Home On the day of the procedure make sure that you rest for a couple of hours before resuming your normal daily activities. It is important that you monitor the effect of the injection on your pain over the next couple of weeks as this will assist doctors in planning further treatment. Most people find that the pain is reduced within a few days after the epidural injection. Try to increase your exercises moderately if the effects of your injection appear to have been successful. However it is important when doing your exercises that you do exercise into the pain, you must stop the movement at the point before the pain is felt. If you have been given sedation it is important that in the following twenty four hours: You Do Not drive as your insurance will not cover you. You Do Not operate machinery (including cooking and using other domestic appliances). You Do Not drink alcohol. You Do Not make important decisions. You are Not left alone in the house to look after small children. Following your procedure an out patients appointment will be arranged in order for you to evaluate the effectiveness of treatment and discuss further management with the Non Acute Pain Team. If There Is A Problem If you have any concerns about anything relating to the appointment date or time please contact the Non Acute Pain Secretary. If you have any concerns relating to your procedure please contact the pain nurse. Contact Numbers: The Non Acute Pain Secretary can be contacted: Mon-Fri 9am-5pm on 0161-922-6816 The Non Acute Pain Nurse can be contacted on: Monday-Friday on 0161-922-6986/ 6759 N.B. Outside these hours leave a message and the secretary or the nurse will get back to you. However if the matter is urgent please contact your GP, NHS 111 or attend your local accident and emergency department. Other Useful Contacts or Information NHS 111 The Trusts Patient Information Centre 0161 922 5332 British Pain Society 020 7269 7840 / www.britishpainsociety.org/home Epidural injections for Non Acute Pain Patient Information Leaflet Page 7 of 9
Source of Good Practice W.B. Saunders (1999), Atlas of Regional Anaesthesia, 2 nd Ed., Philadelphia Samanta A., Samanta J. (2004), Is epidural injection of steroids effective for low back pain?, BMJ Vol: 328; p.p. 1509-1510. ABPI, Compendium of Data sheets and summaries of product characteristics,1999-2000. Northwest Chronic Pain Group, Pain Management Service Epidural Injection Leaflet, UK. Melzack R. Wall P. D., (1984), Text book of Pain, Churchill Livingstone, London If you have any questions you want to ask, you can use this space below to remind you. If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these options please contact the Patient Information Centre on 0161 331 5332 Epidural injections for Non Acute Pain Patient Information Leaflet Page 8 of 9
Document control information Author: Jayne Grant, Clinical Nurse Specialist Pain Service Dr B. Ousta, Consultant Anaesthetist, Non Acute Pain Dr M. Ramay, Consultant Anaesthetist, Non Acute Pain Sr Kirstine McClure, Non Acute Pain Service Division/Department: Anaesthetic Department Date Created: July 2013 Date Reviewed Janaury 2017 Reference Number: NAP 010 Version: 2.2 Epidural injections for Non Acute Pain Patient Information Leaflet Page 9 of 9