Lumbar Epidural is execute for chronic pain , mostly radiating into the low extremities . The chronic lumbar annoyance also called as sciatica or radiculopathy may or may not be affiliate with tingling , numbness as well as weakness of the low-spirited extremities . The procedure is perform either for symptomatic purpose or therapeutic reasonableness .
Diagnostic shot is performed to assess the cause of the pain . There are 5 lumbar nerves which are passing into the lower extremities . The pain may derive from any one of the 5 or it may call for more than 1 lumbar nerve . understanding diagnostic injection is performed is to discover out the level of the nerve which is pinched either by disc herniation or bulge magnetic disk and to perform the injection so pain is relieved and the drive of the pain is possibly treated with operative treatment .
Therapeutic injectant is execute if the patient is not a candidate for operation or any other treatment and not reply to oral pain medications and any other treatments . therapeutical injection are performed multiple time and repeated every 3 to 6 month .
symptomatic injection or therapeutic injection of the operation transforaminal injectant is done in the operating room . The operative center provides the desex environment which is important to prevent any infection in the extradural quad .
Patient is brought in the operating room and ask to lie in prone position which is on the tummy . The pillow is kept underneath the patient ’s venter or over the operating layer . X - irradiation is used to distinguish lumbar vertebrae . The symptomatic shot is do at the selected nerve either lumbar heart 1 , 2 , 3 , 4 , or 5 . The grade requested for the symptomatic injection depends on finding of the clinical examination , MRI studies , CAT scan and EMG examinations .
If the patient role is scheduled for diagnostic injectant , then 1 or 2 level injections are perform the same time . If the patient is schedule for healing injectant , then up to 3 degree of injectant are performed the same time .
Once the patient is in the operating elbow room , on the bed in prone position , the x - ray is used to key the level of the foramina where the shot is to be do . The local anesthesia is used to anesthetize the skin as well as subcutaneous tissue paper . AP view of the ecstasy - ray of light , lateral or devious view of the Adam - ray is used for the procedure . Once the foramen is observed using the 10 - light beam , the needle entry item is mark with denounce pen . The skin over the needle entry point is anesthetized with local anesthesia . Local anesthesia used for skin and subcutaneous tissue is 1 % Lidocaine . The amount used is 1 to 2 milliliter . The medication is come in using 25 bore needle . After local anesthesia , the acerate leaf is passed under the x - re guideline in to the foramina from oblique side . The acerate leaf is very carefully stick in into the foramina . Sometimes affected role may feel a parasthesia which means patient may have a severe pain passing through the cheek into the leg if the acerate leaf is touching the nerve . In that casing , cautiously spunk have to be placed on the side of the nerve . The needle placement is super important to prevent any ramification . disco biscuit - electron beam guideline and frequent variety of the view of the x - ray either AP , sidelong , or oblique is necessary to forestall the passing of the needle into the extradural space or into the spinal place . Once the needle is placed into the foramina , the dyestuff is inject . The dyestuff spread along the mettle is observed . The dyestuff will spread along the nerve and exterior direction as well as into the spinal canal . After verification of the acceptable placement of the spinal acerate leaf , the process is perform by inject the medicinal drug . Medications injected are normal saline , local anaesthesia , and cortisone shot . Cortisone injection used is either Depo - Medrol or Kenalog while local anesthesia used is 2 % Lidocaine or Bupivacaine . The local anesthesia which is used should not have any preservative . After the procedure , acerate leaf is removed , patient is transferred to the recuperation elbow room and affected role is observed for any further ramification . Patient is exonerate home if there is no knottiness . patient role is judge following the procedure as well as first visit after the injection in the office .
