Sedation for epidural steroid injections

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

This is a rare complication that may occur if a small hole is made in the fibrous sac and does not close up after the needle puncture. These small holes are only made in less than 1% of epidural injections and usually heal on their own. The spinal fluid inside can leak out, and when severe, the brain loses the cushioning effect of the fluid, which causes a severe headache when you sit or stand. These types of headaches occur typically about 2-3 days after the procedure and are positional - they come on when you sit or stand and go away when you lie down. If you do develop a spinal headache, it is OK to treat yourself. As long as you do not feel ill and have no fever and the headache goes away when you lay down, you may treat yourself with 24 hours of bed rest with bathroom privileges while drinking plenty of fluids. This almost always works. If it does not, contact the radiologist who performed the procedure or your referring physician. A procedure (called an epidural blood patch) can be performed in the hospital that has a very high success rate in treating spinal headaches.  

Patients under general anesthesia must undergo continuous physiological monitoring to ensure safety. In the US, the American Society of Anesthesiologists (ASA) have established minimum monitoring guidelines for patients receiving general anesthesia, regional anesthesia, or sedation. This includes electrocardiography (ECG), heart rate, blood pressure, inspired and expired gases, oxygen saturation of the blood (pulse oximetry), and temperature. [5] In the UK the Association of Anaesthetists (AAGBI) have set minimum monitoring guidelines for general and regional anesthesia. For minor surgery, this generally includes monitoring of heart rate , oxygen saturation , blood pressure , and inspired and expired concentrations for oxygen , carbon dioxide , and inhalational anesthetic agents. For more invasive surgery, monitoring may also include temperature, urine output, blood pressure, central venous pressure , pulmonary artery pressure and pulmonary artery occlusion pressure , cardiac output , cerebral activity , and neuromuscular function. In addition, the operating room environment must be monitored for ambient temperature and humidity, as well as for accumulation of exhaled inhalational anesthetic agents, which might be deleterious to the health of operating room personnel. [6]

What should I do and expect after the procedure?
You may have some partial numbness in your buttocks and/or legs from the anesthetic after the injection. This may last several hours but you will be able to function safely as long as you take precautions. You will report your remaining pain (if any) and also record the relief you experience over the next week in a “pain diary” which we will provide. *Mail or fax the completed pain diary in the envelope provided, so that your treating physician can be informed of your results and plan future tests and/or treatment if needed.

Sedation for epidural steroid injections

sedation for epidural steroid injections

What should I do and expect after the procedure?
You may have some partial numbness in your buttocks and/or legs from the anesthetic after the injection. This may last several hours but you will be able to function safely as long as you take precautions. You will report your remaining pain (if any) and also record the relief you experience over the next week in a “pain diary” which we will provide. *Mail or fax the completed pain diary in the envelope provided, so that your treating physician can be informed of your results and plan future tests and/or treatment if needed.

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