Spinal Injections

What is a Facet/Sacro-Iliac joint Injection?

These are injections performed to help relieve your pain. Injections may be given into facet joints/sacro-iliac joints or nerve roots. Facet joints are small weightbearing joints in the back. Sacro-iliac joints are large joints at the lower end of the spine and nerve roots are where nerves exit from the spine. Unfortunately joints are prone to wear and can become inflamed and subsequently both of these can cause pain.

The injection of local anaesthetic and steroid may provide temporary relief from pain but you should follow a regular gentle course of daily exercises, otherwise the pain may return.

What is an Epidural Injection?

An Epidural injection is an injection of local anaesthetic and steroid solution into the epidural space. The Epidural space is located around the outer covering of the spinal cord from the base of the skull to the bottom of the spine. Through this space pass the nerve fibres from the spinal cord. The local anaesthetic acts on the nerves and temporarily blocks their function. Steroids decrease inflammation and improve the chances of longer- term pain relief from the injection.

The anti-inflammatory effect of 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 designed for the epidural space (license). However using standard precautions epidural injections have been used since the early 1970s and are considered to be very safe by national and international pain organisations.

Why is it performed?

Epidurals are performed most commonly for pains in the leg, back, and neck including inflammation of the nerves. The injection helps to reduce pain temporarily, and by doing so aim to improve mobility. We hope that you will take the opportunity to regularly perform back strengthening exercises which are the best way to improve the function of the back over the longer term. The injection may be used to relieve pain running from the back down the legs but is often not helpful when the pain affects only the back. The longer the symptoms have been present, the less successful the outcome. Even with the same symptoms the results can vary from person to person.

What happens first?

The procedure is performed as a day case. You may be required to stay for approximately half a day. You need to let Mr Ridgeway’s team know:

1. If you are allergic to local anaesthetic.
2. If you are allergic to steroids.
3. If you are or you think you may be pregnant.
4. If you have an infection near the injection site or elsewhere
5. You are experiencing any difficulty or frequency in passing urine
6. If you have recently been vaccinated or planning to have a vaccination
within one month of your appointment it is important that you call our secretary to re-schedule your appointment, otherwise your procedure may be cancelled.
7. If you have had a heart attack within the last twelve months.
8. If you are taking Antibiotics or have finished a course in the three weeks prior to your procedure.
9. If you are taking any blood thinning drugs such as Warfarin, Sinthrone, Aspirin, Clopidogrel, Ticlopidine, you will need advice on when to stop taking these medications prior to your admission otherwise your procedure may have to be cancelled.
10. Patients receiving sedation should not eat or drink for 6 hours prior to their procedures.

PLEASE NOTE:

• Please ensure that you have a light breakfast on the morning of your procedure. You may also have clear fluids to drink up to two hours before you are admitted for your procedure.
  
  
• If you are Diabetic you may eat and drink normally, and take your usual medication for your diabetes.
  
  
• Please take your usual medication on the day of admission with a tiny amount of water and bring your medication into hospital with you.
  
  
• If you have had recent surgery or a recent illness please inform us by telephone prior to your appointment on
  
  
• If you are unwell on the day of your procedure please contact the hospital.
  
  

What will happen to me after the procedure?

Immediately after the procedure and for a period of 2-4 hours you may feel that the area which has been injected with the anaesthetic solution feels numb and heavy and you may have some leg numbness. This is to be expected and will usually settle within a few hours. You are advised to seek assistance from the nursing staff on the unit when you want to stand and walk following your injections in case your legs are weak. It is essential that you are able to pass water without problems and mobilise safely. You may have a dressing to the injection site. This can be removed after 24 hours

If you have been given sedation it is important that in the following 24 hours:

• It is not advisable to drive for 24 hours following this procedure. (Your insurance will not cover you)
  
  
• You do not operate machinery (This includes cooking and other domestic appliances)
  
  
• You do not drink Alcohol
  
  
• You do not make important decisions
  
  
• You are not left alone in the house to look after small children
  
  

Once at Home

On the day of the procedure do rest for a couple of hours before resuming your normal daily activities. It is important that you monitor the effect of the injection on your pain over the next couple of weeks as this will assist doctors in planning further treatment. Most people find that the pain is reduced within a few days following the epidural injections. For a small number of people however, the pain can be made worse, temporarily or permanently. If you become concerned about any matter following the procedure, please telephone the Pain Nurse on a Tuesday morning (9am-10am) or if the matter cannot wait then please contact your General Practitioner, or alternatively contact NHS Direct or you’re your local Accident and Emergency Department

Who should then advise you?

Following your treatment an out -patients appointment will be arranged in order for you to evaluate the effectiveness of treatment and discuss further management with The Non Acute Pain Management Team.

Please note.

It is possible you may experience prolonged weakness which may require you to remain in hospital for longer until this passes. Please bring with you your normal medication and extra to allow for this eventuality as not all the wards have access to the range of medication you may currently be taking. Before being discharged.

Please do not drive yourself to the hospital, you will not be able to drive yourself home after the procedure. You should arrange for a responsible adult to collect you and take you home by car or taxi. You should also arrange that a suitable adult is available to stay with you. If this isn’t possible, your procedure may not go ahead as planned. Please ensure you follow the instructions you are given about rest, exercise and how long to stay off work.