Lumbar Epidurals

What is a Lumbar Epidural?

Lumbar epidurals are injections to treat and relieve low back pain. A lumbar epidural involves injecting a local anaesthetic and an anti-inflammatory steroid into the epidural space of the lower spine (lower back) to reduce inflammation causing the pain.

The epidural space is the area between the dura mater (a membrane covering the spinal cord) and the vertebral wall of the spine. This contains nerves, blood vessels and soft tissues. 

Indications for the Procedure 

The typical indication for the procedure is acute or chronic low back pain that radiates down your leg, which can be caused by various medical conditions or infection.

How do you Prepare for a Lumbar Epidural?

You may be told to do the following to prepare for the procedure: 

• Stop taking antibiotics (if applicable) 4 weeks before the epidurals.
• Avoid using blood thinners (if applicable) two weeks before the procedure. 
• Stop eating or drinking for specific hours prior to the injection.
• Arrange a driver to take you home after the discharge.

How is the Procedure Performed?

The procedure usually takes between 15 to 30 minutes and is performed in a surgery centre, hospital, or a physician's clinic. 

During the procedure:

• You will lie on your stomach on an X-ray table with your back slightly curved by a pillow under your abdomen.
• Alternatively, you may sit upright or lie on your side in a slightly curled position.
• The skin in the low back area is cleaned and then numbed with a local anaesthetic.
• A fluoroscope (live X-ray) is positioned to guide a needle to the injection site.
• The needle is inserted into the skin and directed towards the epidural space. 
• Proper position of the needle is confirmed by injecting contrast (dye) into the location. 
• The steroid is then injected slowly to the affected area in the epidural space.
• You are likely to be monitored for 15 to 20 minutes before being discharged.

The number of epidurals required vary and can be anywhere between one to three injections.

Risks and Side Effects Associated with Lumbar Epidurals

Risks of lumbar epidurals include:

• Increase in the pain for several days 
• Numbness of the bowels and bladder
• Puncture of dura mater leading to headache 
• Infection, bleeding, nerve damage

Possible side effects are:

• Facial flushing (anxiety)
• Sleeplessness
• High blood sugar
• Arthritis of the hips 
• Cataract (decrease in vision)
• Stomach ulcers

What Precautions should be Taken as You Recover from the Procedure?

As you recover from the procedure, you may need to:

• Apply an ice pack as instructed by your doctor 
• Adequately rest for a specific period of time 
• Avoid driving or rigorous activity for at least a day 
• Avoid taking a bath or using a hot tub for 24 hours 

Benefits of Lumbar Epidurals?

Lumbar epidurals are safe, effective and non-surgical and help to:

• Control inflammation
• Relieve pain 
• Minimize the use of pain medicines
• Delay or avoid surgery
• Boost mental health 
• Improve the quality of life