• Reference Number: HEY-609/2020
• Departments: Pain Medicine
• Last Updated: 29 May 2020

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is an epidural injection?

An epidural injection is one method that is used to provide pain relief. It has been used for many years as an effective form of pain relief during childbirth.

An epidural is an injection into an area of your back that surrounds the spinal cord. Local anaesthetic and steroid will be injected. This will bathe the nerve roots which may have an effect on your pain.

Epidural injections can be given anywhere along the length of the spine. This may be in the neck (cervical), ribs (thoracic), lower back (lumbar), or tailbone (caudal).

Advice to be read before having a pain relief procedure

The following information has been produced to ensure that you are able to have your pain relief procedure. It is essential that you read and follow the advice given below before you come to the hospital. If you do not follow the advice you may not be able to have your treatment.

Please contact the Pain Clinic if any of the following apply to you:

• You have recently had an admission to hospital.
• You have tested positive for Meticillin-resistant Staphylococcus aureus (MRSA).
• You have an infection and are currently taking antibiotics.
• You think you may be pregnant.
• You are diabetic and take medication to control your diabetes. (See below on how to manage treatment sessions booked for morning or afternoon)

Advice for diabetic patients only

If you are a diabetic booked to attend treatment in the morning, you should not have breakfast and do not take your morning medication but bring your medication with you to the clinic.

If you are booked for treatment in the afternoon then have breakfast and take regular medication 6 hours before treatment. Continue to drink clear fluids (not milk) for up to 2 hours before the procedure. Please inform clinic staff as soon as you arrive that you are a diabetic.

Before the procedure

Solids and milk-containing drinks should not be consumed within 6 hours of the beginning of the procedure.

Patients attending a morning appointment should not eat anything for 6 hours before the procedure. Most patients will not usually eat after midnight and this is a convenient cut-off point.

Patients for an afternoon appointment should have a light breakfast at least 6 hours prior to the start of the list.

Continue your other regular medications including your pain relief medication except for anticoagulants (please see below).

Please continue with your other regular medications including your pain relief medication except for anticoagulants. If you take Warfarin, (Marevan) Clopidogrel, (Plavix), Dipyridamole (Persantin Retard), Phenindione, Pradaxa, Xarelto, Sinthrome or Asasantin Retard, please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this.

You may have to wait a while before your procedure, so please bring something to read or keep yourself occupied.

Please leave any valuables or jewellery at home. It is essential that after the procedure you arrange for an adult friend or relative to collect you by car or taxi. You will not be able to drive or use the bus or train to travel home.

Hospital transport may be available if there is a medical need. If you think you may be eligible please contact the Pain Clinic.

Treatment takes place as an outpatient at the Day Surgery Unit, Castle Hill Hospital (CHH) or Hull Royal Infirmary or Westwood suite (CHH). This will be confirmed at your clinic appointment.

You will have either a morning or an afternoon appointment. On arrival, you may be asked to complete questionnaires.

Your stay may be between 2 to 4 hours. Before any treatment begins you will be asked to provide assurance that someone is able to drive you home.

You will be asked to change into a theatre gown and your blood pressure and pulse will be recorded. Your doctor will then discuss the procedure with you and ask you to sign a consent form.

The procedure

In the treatment room, you may have a small needle (cannula) placed in the back of your hand. This allows the doctor to give you sedation if necessary.

Once you are lying or sitting in the correct position, the doctor will clean your back with an antiseptic solution which can feel very cold.

The procedure may be carried out under X-ray screening.

Local anaesthetic is injected into your back which may sting at first, but the area will soon go numb. When the epidural injection takes place you may feel a pushing sensation or some discomfort.

Contrast (a solution which shows up under X-ray) may be injected to make sure that the needle is in the correct position.

Drugs can then be injected and a feeling of tightness may be felt. A cold spray may be used over the injection site once the procedure is completed or a small dressing may be applied over the procedure site.

After the injection

You will be taken to the recovery area where the nursing staff will observe you. You may feel a little drowsy and wish to sleep. You will lay flat for approximately 30 minutes and then will be given assistance to sit up. We will offer you some light refreshment.

Your blood pressure and pulse will be checked frequently. You should be able to demonstrate that you are able to walk and pass urine before discharge.

Before you leave, the doctor may see you again and ask a few questions about your pain and any effects that the injection may have had.

Please ensure that you have arranged for someone to drive you home after this procedure. Failure to do so will result in your procedure being cancelled.

If you have had sedation, we recommend that you arrange for someone to stay with you overnight and that you do not drive for 24 hours.

Can there be any complications or risks?

Although long term side effects and complications are uncommon, they can occur.

Not all nerves in the epidural space carry pain messages. Some nerves carry instructions to the leg muscles. If these nerves are numbed then your legs could temporarily become heavy or weak.

Also, you may be unaware of the need to pass urine; this will be temporary.

You may have mild local tenderness at the site of the injection, which will usually settle over the next few days. Sometimes after the procedure your blood pressure can fall and you may feel faint.

On rare occasions during insertion of the epidural needle, the layer beneath the epidural space gets punctured. You may then get a headache.

If a severe headache develops following your injection, take some paracetamol, drink plenty of water and lay flat. If the headache continues for more than 24 hours please contact your doctor or the Pain Clinic.

Other risks could include an increase in pain, infection, bruising, bleeding or nerve damage.

What to expect afterwards

Some rapid relief of your pain may be noticed due to the local anaesthetic. It could take several days before the steroid becomes effective.

Take your regular pain medication relief as normal. Try to keep on the move about the house but do not do anything too strenuous.

As your pain decreases you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike or swimming on your back will help to improve your muscle tone and strengthen your back. The best way is to increase your activity slowly. Try not to overdo things on a good day as this may result in you experiencing more pain the following day.

Follow up

A letter will be sent to your doctor and you will be reviewed either by telephone or seen at the Pain Clinic in due course.

Points to remember

• You will need to arrange for someone to drive you home after this procedure.
• Please bring your glasses if you need them for reading.
• Always bring a list of all current medication.
• Continue taking all your usual medication on treatment day.
• If there is any possibility you may be pregnant please inform the doctor or nurse.
• If you are planning to travel abroad or fly within two weeks after the injections, please let your doctor know as it may be best to change the date of the injections.

Additional information

The information in this leaflet is not intended to replace the advice given to you by your doctor or the Pain Service looking after you. If you require more information or have any questions, please speak to your doctor or the Acute Pain or Chronic Pain Services who are looking after you.

If you experience unusual symptoms such as a marked increase in pain/swelling around an injection site, fever, severe headache, new symptoms of pins and needles, new muscle weakness in your arms, or you are very concerned about how you feel after the procedure, please contact your doctor.

 In the event of an emergency and outside normal working hours (9.00am – 4.00pm) of the Pain Clinic please contact your own doctor, Local Walk in Clinic / Minor Injuries Unit

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Pain Service, Outpatients Department, East Riding Community Hospital, Beverley Pain Service (01482) 478868

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.