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With imaging modalities such as ultrasound, CT scan and flouroscopy, our physicians are pinpointing the problem spots and treating the pain with more accuracy than ever. These new techniques keep complications at a minimum. By attending medical conferences and workshops, our physicians are always finding ways to improve patient care and keep up with the latest technology.
Patients who are booked for procedures (especially those on the spine) are often very anxious on the day of the procedure. Depending on the patient and procedure, our physicians may require the assistance of an anesthesiologist to administer mild sedatives and monitor the patient’s vital signs. Some of the bigger surgical procedures such as spinal cord stimulator and intrathecal pumps require heavy sedation or even general anesthesia. While the patient may take his or her usual medicines (excluding Xarelto, Plavix, Coumadin, or any other blood thinner/antiplatelet medication) with a sip of water, it is mandatory that patients do not eat for 8 hours prior to a procedure that may require sedation or anesthesia. Patients may have a sip of waters with pills up to 2 hours prior to the procedure. Those taking medication for diabetes are asked to consult the prescribing physicians for medication instructions when fasting to avoid hypo or hyperglycemia
Patients are expected not to drive, drink alcohol, or make any important business decisions on the days of their procedure. While those who received anesthesia may have a more difficulty concentrating than those who did not, some patients may require an escort (friend, family member, home health aide, etc.), who can take the patient home post procedure.
Most patients are scared of pain more than anything else. As the area of injection is often an inflamed area, there may be some pain. Each case is different, and patient responses are often variable. Many patients report that the pain of the IV insertion is worse than the actual injection. Our physicians are very sensitive to this. This is why we are very generous with the local anesthesia prior to injections. In addition, the anesthesiologist may give some sedation prior to needle insertion.
Complications are very rare. Infection, bleeding and nerve damage are on the orders of one in hundreds of thousands, while a headache after an epidural has a less than 1% occurrence rate. Other problems relate to the medications used. Contrast agents (which enable us to see structures on the x-ray) can on rare occasions be associated with kidney problems and allergies (especially in those who are allergic to Iodine and shellfish). Other problems encountered may relate to vasovagal events (fainting), and steroid side effects. The steroids used are given only in local areas, and therefore do not cause significant systemic side effects in most people, but diabetics and hypertensives (people with high blood pressures) may experience a worsening of their diseases. In addition, women may experience changes in their menstrual cycles. Other complications may occur, but those listed above are the ones most commonly asked about and discussed on a typical procedure day.
Epidural steroid injections do not cure herniated discs or spinal stenosis. They treat the pain and radiculopathy associated with these conditions by reducing the inflammation caused by the narrowing in the spinal canal. The reduction of inflammation and pain enables the patient to perform physical therapy and stay active. Maintaining flexibility, muscle tone, and an active life style are what help improve the long term prognosis for patients suffering from these conditions.
It depends. Muscle injections usually consist of local anesthetics. Diagnostic median branch nerve blocks consist of local anesthetic, but occasionally contain steroid solutions. Most joint, facet, and epidural injections consist of both local anesthetic (lidocaine or bupivicaine), and steroid (depomedrol or kenolog). The idea is to provide short term pain relief, and long term pain relief through the lessening of inflammation (steroid effects). It is important that the patient disclose any previous steroid use, as the effects can be additive and increase the risk of side effects.
Some patients (for various reasons) are candidates for ultrasound guided nerve blocks. The ultrasound is increasingly being used to perform nerve blocks because of its accuracy. It enables physicians to distinguish between nerve, muscle, blood vessels, and other structures. As new technologies have enabled our physicians to place catheters in the vicinity of a nerve, we are able to treat selected patients with continuous infusions that may enable them to participate in physical therapy without pain.