The epidural steroid injection procedure takes place in a surgery center, hospital, or a physician's clinic. Many types of physicians can be qualified to perform an epidural steroid injection, including an anesthesiologist, radiologist, neurologist, physiatrist, and surgeon.
Patients may be asked to change into a hospital gown, which allows for access to clean the injection area and to allow the physician to easily visualize the injection site. An epidural steroid injection usually takes between 15 and 30 minutes and follows a relatively standard protocol:
Sedation is available for patient anxiety and comfort. However, sedatives are rarely necessary, as the epidural steroid injection procedure is usually not uncomfortable. If a sedative is used, some patient precautions should be taken, including not eating or drinking for several hours prior to the procedure and having a guardian available for discharge. A patient should contact his or her doctor for specific instructions.
Tenderness at the needle insertion site can occur for a few hours after the procedure and can be treated by applying an ice pack for 10 to 15 minutes once or twice an hour. In addition, patients are usually asked to rest for the remainder of the day on which they have the epidural steroid injection. Normal activities (those that were done the week prior to the epidural injection) may typically be resumed the following day. A temporary increase in the pain can occur for several days after the injection due to the pressure of the fluid injected or due to local chemical irritation.
In addition to understanding the general protocol and time involved in the procedure, patients should discuss with their clinician and physician whether pain medications (or certain other medications) can be taken on the day of the injection.
There is no definitive research to dictate how many epidural steroid injections should be administered or how frequently they should be given. In general, the consensus is to perform up to three epidural injections per year, which is about the frequency that many arthritis patients receive cortisone shots for shoulder and knee pain. Different strategies are used: