CAUDAL (EPIDURAL) STEROID INJECTION

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1 CAUDAL (EPIDURAL) STEROID INJECTION Information Leaflet Your Health. Our Priority.

2 Page 2 of 5 What is a Caudal Epidural Steroid injection? A caudal epidural injection is an injection of steroid (anti-inflammatory medication, also referred to as cortisone ) into the epidural space at the bottom of the spine. The epidural space is located around the outer covering of the spinal cord. It runs from the base of the skull to the bottom of the spine along the entire length of the spinal canal. Nerve fibres carrying pain signals to the spinal cord and the brain pass through this space. The steroid decreases inflammation and can relieve pain. The anti-inflammatory steroids should not be confused with anabolic steroids that athletes have used for building up muscle mass. Unfortunately no company actually produces a steroid specifically licensed for the epidural space. However, using standard steroid preparations, epidural injections have been used since the early 1970s and are considered to be very safe by the national and international pain organisations. Why is the injection given? The injection is usually given for patients with buttock pain, back and leg pain or tail end pain due to injury, inflammation of the nerves, or arthritis. A caudal epidural injection is sometimes done in patients who have persisting pain after spinal surgery. The injection helps to reduce pain, improve mobility, facilitate physiotherapy and thus improve function. By achieving a reduction in pain we hope that you will take the opportunity to regularly perform muscle strengthening exercises which is the best way to improve function over the longer term. How is the injection done? You will be asked to come to the Maple Suite. The injection can be done with you lying on your side or on your front. The caudal epidural injection site will be cleaned with antiseptic and local anaesthetic injection is given to numb the skin. A needle is inserted at the bottom end of your back. The Doctor confirms the position of the needle with the help of an x-ray machine, and then the steroid is injected into the caudal epidural space. What are the beneficial effects? The injection may help to relieve buttock / tail end pain, and back and leg pain. The pain relief may take days or weeks to take effect. Some patients get more pain relief than others and some may not get any relief at all. In some groups of patients the injection will help by reducing the number of painkillers that are required to control the pain and by improving the quality of life. What are the side effects of the injection? You will typically get some injection site pain after the procedure and may initially experience some increase in your pain. It is usually self-limiting and easily controllable with painkillers. There may be some local bruising and tenderness on your skin. If local anaesthetic is injected into the epidural space then this can also temporarily numb the nerves that control your blood pressure, and cause some weakness and numbness in the seat area and legs. The decrease in blood pressure can make you light headed and unsteady on your feet. This is easily remedied by lying down and only occasionally by using a drip or medication. Infection, bleeding, excessive spread of the numbness, nerve damage and damage to surrounding tissues are other extremely rare side effects which may require special treatment. Extremely rarely spinal injections can cause permanent nerve injury or damage.

3 Page 3 of 5 Risk of nerve injury: Nerve injury is a very rare risk following spinal injections (1:40,000), this can affect the nerves inside the central canal of the spine, or the individual nerve roots as they exit the spine. This can come about as a result of direct injury, infection, or bleeding. Nerve injury can be temporary or more rarely permanent. Nerve damage can lead to pain, weakness, and numbness in the area supplied by the injured nerve, such as the trunk and legs and can affect bladder and bowel sphincter control. Actual spinal cord damage is extremely rare, but this can cause more serious and long lasting disability and pain. These risks are extremely rare and you can discuss them with your doctor on the day, however we are required to mention them because of the serious consequences in the very rare event that they should occur. Reference: 3rd National Audit Project (NAP3) The Royal College of Anaesthetists. - Complications after CNB for Chronic Pain. Potential side effects with use of steroids There are very few side effects associated with single or occasional use of steroid injections. Hot flushes, feeling sick or having mild abdominal pain are sometimes felt. Control of diabetes may be difficult, and menstrual irregularities may occur. These typically settle within a few days/weeks. Repeated and frequent steroid injections will potentially increase the risk of more serious side effects, but it must be kept in mind that the dose that is used in the injections is very small compared to those taking steroids by mouth on a daily basis for conditions such as asthma or arthritis. In those circumstances, side effects such as increase in appetite, weight gain, thinning of the bones (osteoporosis), thinning of the skin, eye problems (glaucoma, cataract), weakness, depression, rounded face, high blood pressure and water retention have been seen. Oral contraceptive pills may increase the level of steroids in the blood. Advice/Precaution You will be required to stay in the hospital for up to one hour after the procedure. You should not drive after spinal injections for the rest of the day. Care should be taken when walking as occasionally the power, sensation and balance in your legs can be slightly affected for a few hours, if there any concern with your mobility we may keep you in hospital for longer/overnight. Ensure you have a responsible adult to ensure you get safely home, and then rest until you feel you have recovered. Once safely at home, there is usually no need for you to be accompanied overnight unless sedation has been administered. If alone, ensure you have a telephone to hand in case help is needed. A follow up appointment will be arranged, so that the doctor / nurse can review the effects of the treatment. Subsequently you should carry on with your normal activities, try to increase the exercises and aim to reduce your pain killers if the effect of the injection appears to have been successful.

4 Page 4 of 5 It is very important that you inform the Doctor or Secretary of the pain clinic, at least a week before the injection: If you are allergic to any medications If you are on blood thinning medication such as Warfarin, Nicoumalone (Sinthrome), Dagibatran, Aspirin, Clopidogrel (Plavix), Ticlopidine (Ticlid), Dipyridamole, ticagrelor. (note: Aspirin 75mg would not cause problems and should be continued) If you have an infection near the injection site. If you have had a recent steroid / cortisone injection in the hospital or in your surgery. If you think you might be pregnant If you are a Diabetic and have poorly controlled blood sugars, a steroid injection could aggravate this. Caution should be exercised if you have had a recent heart attack or vaccination. Please inform the pain clinic. The information contained in this leaflet is for educational purposes only, please discuss with your doctor if you require further information. Contact us If there are any concerns or queries please contact the Pain Clinic on

5 Page 5 of 5 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number CC19 Publication date June 2016 Review date June 2018 Department Surgical and Critical Care, Pain Team Location Stepping Hill Hospital