© Mr Amer Karim (2016)
Mr Amer Karim
MBBS(London), DIC(Orth Eng), MD(Res)
FRCS(Trauma & Orth), FRSA(UK)
Consultant Trauma & Orthopaedic Surgeon
Full British Training & Specialist Certification
Caudal Epidural Injection for Back Problems
What is a caudal epidural?
A caudal epidural is an injection of very dilute local anaesthetic and some steroid given into the spine, around the nerve roots of the lower back.
How can an epidural help?
A caudal epidural may ease the symptoms you are experiencing and can give you long lasting relief. It works by reducing the inflammation and swelling around the nerve roots that reduces the "pinching" on them from scar tissue, disc prolapses, spinal stenosis and arthritis.
As well as reducing the pain, a caudal epidural can assist your recovery, as you will be able to move more normally and participate in appropriate physiotherapy or exercise.
If your condition has occurred recently you are very likely to benefit, however if your condition has been present for a long time or has come back you may require more than one caudal epidural to get the maximum benefit.
Are there any risks?
Immediately after the injection, your legs may feel tingly and heavy. This is because the local anaesthetic partially blocks the nerve to your legs. It will wear off after a few hours. It is important not to get out of bed and try to walk until your legs feel completely normal. Your blood pressure may drop a little. This is likely to return to normal soon after the procedure. It may be difficult to pass urine for a few hours after the procedure. This will return to normal without any treatment. You should make sure you pass urine before you leave hospital.
As with any injection, there is a very small chance of getting an infection where the needle is placed. Every effort is made to avoid this with use of skin-cleaning solution, sterile gloves and equipment and even filtered air in theatre.
Very occasionally, some people get a severe headache after an epidural. If this should happen, let the staff in recovery or ward know. If you get a bad headache when you have gone home, tell your GP or contact the ward.
Very rare complications include fits, nerve damage and epidural haematoma (blood clot). Whilst the risks of bleeding and infection are very very small (<0.01%), the consequences of this happening are serious and you must be aware of them.
The procedure is made as safe as possible through experience and I have performed hundreds of these injections without incident. I also use x-rays to show exactly the epidural needle is placed and constantly monitor you throughout the procedure.
What should I do before my admission?
Please arrange for someone to bring you into hospital on the morning of your admission. You will need to make arrangements for your journey home, as you should not drive for 48 hours after the injection. Most patients go home the same day.
What happens on arrival?
You will be welcomed to the ward by a nurse who will check your name and details and make you comfortable. I will then see you and ask you to sign a consent form. If you are female you will be asked to confirm you are not pregnant.
Shortly before your injection is performed you will need to change into a hospital gown. You do not need to remove your underwear.
What happens during the procedure?
You will be taken to the operating theatre as epidurals need to be done in a clean area. A small cannula (tube) will be put into one of the veins in your hand or arm, through which we may give you medicines and fluids if it becomes necessary.
If you are having sedation you will be asked to lie on your tummy with your arms in front of you. and a pillow under your chest. Once you are comfortable, you will receive some sedation and will not be aware of anything else until you wake up.
What happens while I am asleep?
After a short period of preparation time, antiseptic spirit solution will be applied to the area of your back where the injection is to take place, this is usually very cold, the needle is then placed and the injection performed (but you wont remember any of this).
You will wake up in recovery. Your blood pressure, pulse and respiration rate will be monitored frequently for thirty minutes and if all is well you will be returned to the ward. Once on the ward your blood pressure will continue to be monitored, you will need to rest for one hour but will then be ready to go home.
What happens after the procedure?
Sometimes you may feel an increase in the pain coming from your back or neck for several days. The epidural injection may take 10 days or more to relieve your pain. For some people, the injection may not work at all. You may feel weak or tired for a little while after the injection so I advise that you rest for 24 hours. During this time you should not:
Drive a car
Sign any legal documents
Drink any alcohol.
Lift anything heavy
You should continue taking your usual medication and the next day you may take a bath or shower and remove any plasters.
To get the best out of your caudal epidural injection you should:
Continue with your usual medication
Generally keep active, but within your pain limits
Re-introduce previously painful activities gradually over the next few weeks
Maintain any exercise routine you may have been given by your physiotherapist
If you are working you may return to work as soon as you feel able to perform your duties. You will receive an outpatient appointment for approximately six weeks following the procedure.
I will see you in my outpatient clinic approximately 4 to 6 weeks after the injection to see if it has had an effect and to discuss further options for treatment with you. Should you wish to see me sooner or if you have any other questions, please phone my secretary and she will book you in at a time of your convenience.
Back exercises after injections?
Lying on your back with knee together and bent up, slowly roll your knees from side to side, keeping your upper trunk still. Only go as far as is comfortable. Repeat 10 times 2-3 times a day.
Lying on your back with your knees bent, lift one knee towards your chest, place your hands behind it and draw it into your chest, if comfortable to do so. Then swap legs, repeat 10 times 2-3 times a day.
Lying on your back with your knees bent, tighten your stomach muscles and press the small of your back into the bed. Hold for 10 seconds and release. Repeat 10 times 2-3 times a day
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