What is an epidural?

This procedure is named after the space into which the medicines are injected. The epidural space surrounds the spinal fluid space. The nerves after leaving the spinal cord cross the epidural space on their way to the legs. The epidural space is normally empty but is an ideal place to introduce medications that can act upon nerves.

Why might I need a thoracic epidural?

Chest wall pain from irritated, pinched or trapped nerves can benefit from epidurals. Post herpetic neuralgia is another indication. Controversy surrounds the selection of a conventional epidural vs. a transforaminal epidural. Dr. Harries will discuss the relative benefits and risks of each procedure with you. When possible, Dr. Harries prefers to perform a transforaminal epidural for chest wall pain.

 

How is the procedure performed?

You will lie face down on an X-ray table and be made as comfortable as possible. Dr. Harries will then use an X-ray machine to identify where the epidural is to be performed. Your skin will be numbed and then the procedure needle itself will be placed using X-ray guidance in the correct position. Some X-ray dye will be introduced to confirm that the needle is in the epidural space. The medications will then be injected.

What about X-ray?

If epidurals are performed "blind", that is without the use of X-ray; they have been shown to end up in the wrong place 60% of the time even in expert hands. Additionally the spinal cord is very near to the epidural space. Using X-ray allows the physician to see where he is theoretically making this a safer procedure

Can I be sedated ?

Sedation significantly increases the risks of thoracic epidurals.  If a patient is awake, he/she is able to warn the physician of any peculiar sensations that would suggest that the procedure should be discontinued to prevent complications.

 

How long does it take for the epidural to take effect?

Steroid takes approximately three days to start working. For safety reasons, Dr. Harries does not inject local anesthetic into the epidural space in the thoracic spine.

When can I drive?

You should not drive or operate machinery for at least 24 hours.

What are the risks associated with an epidural?

Complications after an epidural are rare. Steroids can result in an increased blood sugar particularly in diabetics. Infection is very uncommon particularly in non-diabetics. Bleeding in to the epidural space is also very uncommon, but potentially serious complication. For this reason, we do not perform an epidural on a patient taking blood thinners such as Coumadin, Plavix or Aspirin. Injury to the spinal cord is extremely rare.  The risks are, however, increased when a patient moves during the procedure or is sedated for the procedure. If you feel that you are too anxious to have an epidural without sedation, then you are probably better off not having an epidural.