What is an Epidural Block?

An epidural block or injection is a minimally invasive treatment during which a steroid and other medications are injected into the epidural space. The epidural space is located within the spinal canal, surrounding the spinal cord and nerves. This is considered a minimally invasive procedure—meaning it involves penetrating the body but is less invasive than surgery.

What Conditions Can Epidural Block Be Used For?

  • Herniated disc
  • Nerve root compression
  • Epidural scarring
  • Spinal canal stenosis

When Is the Procedure Not Recommended?

  • The procedure is contraindicated in the presence of a local infection.
  • In cases of severe scarring or multiple previous spinal surgeries, the expected success rate is lower. In such cases, epidurolysis or another intervention may be more effective.
  • Steroid injections are not recommended for patients who have recently received steroids without clinical improvement.
  • The maximum recommended annual dose is 4 steroid injections. Exceeding this increases the risk of side effects beyond the benefits. This applies to injected, infused, and orally administered steroids, as their side effects are cumulative.

How Is the Epidural Block Performed?

  • In complex cases, the procedure is performed in an operating room under X-ray guidance, while in simpler cases it may be done in the clinic.
  • The procedure takes about 30 minutes, followed by a 30-minute rest period, after which the patient may go home accompanied.
  • The physician numbs the skin, then inserts the needle into the appropriate area and administers the medication.
  • The patient may feel pressure, tingling, or tightness depending on existing scarring or narrowing in the epidural space.
  • Sedation (conscious sedation) is typically not required, but in select cases, it may be used.

What Happens After the Procedure?

  • Rest is recommended during the first few hours. Light home activities are allowed.
  • Pain relief is often noticeable the same day, although the full effect of the steroid may take up to 7 days.
  • Additional painkillers are usually not necessary after the procedure.
  • Normal activities can typically be resumed the next day, but lifting and contact sports should be avoided until full recovery.

What Can the Patient Do to Support Recovery?

Steroid injections should be complemented with physical therapy, which is considered essential for long-term improvement.

What Should You Know About Steroids?

Corticosteroids—commonly referred to as steroids—are powerful anti-inflammatory drugs used in various fields of medicine, including rheumatology (e.g., rheumatoid arthritis) and pulmonology (e.g., asthma).

They work by reducing inflammation through suppression of immune system activity. While inflammation is a natural response to injury or infection, an overactive immune system can damage the body’s own tissues.

Steroids are frequently used in the management of both acute and chronic pain.

They can dramatically relieve pain, often for months. However, repeated steroid injections or oral steroid use becomes less effective over time, and in progressing conditions, may eventually become ineffective.
Due to the potential for serious side effects, no more than 4 steroid injections are recommended per year.

What Are the Side Effects of Steroids?

Steroids suppress inflammation but also inhibit the body’s natural healing mechanisms. They can delay wound healing, impair proper collagen formation, and worsen joint or tendon health when injected into these structures.

Intra-articular (joint) injections are now known to accelerate cartilage degradation, even if they temporarily relieve symptoms.
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Other known side effects include (but are not limited to):

Short-term:

  • Increased blood pressure
  • Elevated blood sugar
  • Agitation

Long-term:

  • Osteoporosis
  • Increased appetite and weight gain
  • Stomach ulcers
  • Weakened immune response
  • Increased risk of infections
  • High blood pressure
  • Sleep disturbances
  • Mood swings
  • Muscle weakness
  • At the injection site: muscle or fat atrophy (tissue wasting)

Pre-procedure Instructions for Epidural Block

Blood thinners such as Coumadin, Warfarin, Plavix, Heparin, Fragmin, and others increase bleeding risk.

If you are taking any of these or similar medications, inform your doctor in advance—do not stop these medications on your own.

What Are the Alternatives?

  • Oral pain medication
  • Infusion therapy
  • Trigger point injections
  • Acupuncture
  • Physical therapy
  • Manual therapy
  • Swimming
  • Electrotherapy/physiotherapy

How Should the Patient Prepare for the Procedure?

  • You may eat and drink normally, unless sedation is planned.
  • A companion is required to ensure safe transportation home afterward.
  • Do not drive or engage in physical labor for 24 hours after the procedure.
  • Wear comfortable clothing.
  • If you are taking short- or long-acting pain medication, your pain management doctor will instruct you whether to continue or adjust the dosage before the procedure.
  • If you have uncontrolled high blood pressure, the procedure must be postponed.

Fasting Instructions for Sedation:

  • Do not eat within 6 hours prior to the procedure.
  • You may drink water up to 2 hours before, but nothing after that.
  • Sedation is optional and can be omitted if the patient prefers.

Possible Complications of Epidural Block

As with any procedure, epidural steroid injection carries risks.

Possible complications include:

  • Pain at the injection site
  • Inflammation
  • Infection (e.g., meningitis, abscess)
  • Bleeding
  • Nerve injury
  • Allergic reaction
  • Headache
  • Difficulty urinating
  • Worsening pain
  • Hematoma
  • Spinal cord compression
  • Paralysis
  • Death

If any of these complications occur, you may contact us within 24 hours. In urgent cases, please go to the nearest emergency department. Let me know if you need this formatted for a brochure, consent form, or educational handout