Where are epidural injections administered. What are the different types of epidural steroid injections. What are the potential risks and complications of epidural steroid injections. How should patients prepare for an epidural injection procedure.

Understanding Epidural Steroid Injections: Purpose and Function

Epidural steroid injections (ESIs) are a common medical procedure used to alleviate pain and inflammation in the spine. These injections deliver anti-inflammatory medication directly into the epidural space, which surrounds the spinal cord and nerve roots. The primary goal of ESIs is to reduce inflammation of nerve roots, thereby decreasing pain in the back or legs.

Dr. Leonardo Kapural, MD, PhD, explains, “Epidural glucocorticoid injections are commonly given to relieve pain and improve mobility without surgery, buying time for healing to occur or as an attempt to avoid surgery after other conservative approaches failed.” This non-surgical approach can provide temporary or sometimes permanent relief, allowing the body time to heal naturally.

Dr. Gerard Malanga, MD, adds, “Epidural injections can be a very helpful adjunct in rehabilitation of patient’s spine pain that radiates into an arm or leg or in the thoracic spine around the chest or trunk. They work by placing cortisone (a potent anti-inflammatory medication) close to an inflamed nerve.”

The Anatomy of the Spine’s Epidural Space

To understand where an epidural is injected, it’s crucial to grasp the anatomy of the spine’s epidural space. The dura mater is a protective membrane that covers the spinal cord and nerve roots. The area surrounding this membrane is called the epidural space, through which nerves travel to the back and legs.

Inflammation in this space can occur due to various factors, such as damaged discs or contact with the bony structure of the spine. This inflammation may lead to pain and discomfort in the affected regions. Epidural injections target this specific area to reduce inflammation and alleviate pain.

Types of Epidural Steroid Injections: A Comprehensive Overview

There are three main types of epidural steroid injections, each with its own unique approach and application:

1. Interlaminar Epidural Steroid Injection
2. Transforaminal Epidural Steroid Injection
3. Caudal Epidural Steroid Injection

Interlaminar Epidural Steroid Injection

This procedure is performed with the patient lying face down. Using fluoroscopic X-ray guidance, the physician injects the anti-inflammatory solution into the epidural space causing pain. This technique is particularly effective for treating spinal disorders that affect the entire spine, such as spinal stenosis.

Transforaminal Epidural Steroid Injection

Similar to the interlaminar approach, the transforaminal injection is administered with the patient in a prone position. This method is more precise but also more complex. It delivers a small volume of medication directly to the problematic area in the spine, making it highly targeted and effective.

Caudal Epidural Steroid Injection

The caudal approach typically targets the tailbone area and is often chosen for pain in the lower spine. Like the other techniques, it utilizes fluoroscopic X-ray guidance to ensure accurate placement of the medication.

Potential Risks and Complications of Epidural Steroid Injections

While epidural steroid injections are generally considered safe, they do carry some potential risks and complications. Understanding these is crucial for patients considering this treatment option.

• Bone demineralization: Corticosteroids may lead to loss of bone density and increase the risk of future fractures.
• Suppression of the hypothalamic-pituitary-adrenal (HPA) axis: This can result in chronic fatigue syndrome symptoms and, in some cases, Cushing’s Syndrome. It may also lead to high blood pressure, bone loss, and type 2 diabetes.
• Immune system suppression: This can increase susceptibility to infections.
• Elevated glucose levels: This is particularly concerning for individuals with diabetes.

Other potential complications include:

• Infection at the injection site
• Allergic reactions to the injected solution
• Nerve injury
• Numbness in the legs
• Bleeding
• Back pain
• In rare cases, paralysis

Preparing for an Epidural Steroid Injection: Patient Guidelines

Proper preparation is key to ensuring a smooth and successful epidural steroid injection procedure. While a local anesthetic is typically administered during the injection, some patients may receive a mild sedative to alleviate anxiety.

Mental preparation is equally important as physical preparation. Patients should have a thorough discussion with their surgeon about the procedure, including potential risks and complications. It’s crucial to communicate openly about any fears or expectations.

Important questions to ask your healthcare provider before the procedure include:

• What are the expected outcomes of the injection?
• How long will the effects of the injection last?
• Are there any activities I should avoid before or after the procedure?
• What are the signs of potential complications I should watch for?
• How many injections might I need, and how frequently can they be administered?

The Epidural Injection Procedure: What to Expect

Understanding the step-by-step process of an epidural steroid injection can help alleviate anxiety and ensure patients are well-prepared for the procedure.

1. Positioning: The patient is typically positioned lying face down on an X-ray table.
2. Sterilization: The injection site is cleaned and sterilized to prevent infection.
3. Local anesthesia: A local anesthetic is administered to numb the area.
4. Guidance: Using fluoroscopic X-ray, the physician guides the needle to the correct location in the epidural space.
5. Injection: The steroid medication is slowly injected into the epidural space.
6. Observation: After the procedure, the patient is monitored for a short period to ensure no immediate complications arise.

The entire procedure usually takes between 15 to 45 minutes, depending on the specific technique used and the number of injections required.

Post-Injection Care and Recovery

After receiving an epidural steroid injection, proper care and attention to recovery are essential for maximizing the benefits of the procedure and minimizing potential complications.

Immediate post-injection guidelines typically include:

• Rest for the remainder of the day following the injection
• Avoiding strenuous activities for at least 24 hours
• Refraining from driving or operating heavy machinery for at least 24 hours, especially if sedation was used
• Keeping the injection site clean and dry
• Monitoring for any signs of infection or unusual symptoms

Patients may experience some temporary numbness or weakness in the affected area, which usually subsides within a few hours. It’s important to note that the full effects of the injection may not be apparent for several days to a week after the procedure.

Effectiveness and Long-term Outcomes of Epidural Steroid Injections

The effectiveness of epidural steroid injections can vary significantly among patients. While some individuals experience immediate and long-lasting relief, others may find the effects to be temporary or less pronounced.

Factors influencing the success of ESIs include:

• The underlying cause of the pain
• The duration and severity of symptoms
• The specific location of the injection
• The patient’s overall health and lifestyle factors

Research suggests that ESIs can be particularly effective for short-term pain relief, typically lasting from a few weeks to several months. For some patients, this period of relief can allow for increased mobility and participation in physical therapy, which may lead to longer-term improvements.

Dr. Steven Richeimer, MD, notes, “Epidural injections can be done at any level of the spine: cervical (neck), thoracic (mid-back), lumbar (low back), and sacral (tailbone area). The thoracic epidural may be a valuable tool in the treatment of mid-back and chest wall pains. These problems might be caused by disc problems, arthritis of the spine, or even shingles.”

Alternatives to Epidural Steroid Injections

While epidural steroid injections can be an effective treatment option for many patients, they are not always the most appropriate or preferred choice. Understanding alternative treatments is crucial for making informed decisions about pain management.

Some alternatives to epidural steroid injections include:

• Physical therapy and exercise programs
• Oral pain medications and anti-inflammatories
• Acupuncture
• Chiropractic care
• Massage therapy
• Cognitive behavioral therapy
• Nerve blocks
• Radiofrequency ablation
• Spinal cord stimulation

The most suitable alternative will depend on the individual’s specific condition, overall health, and personal preferences. It’s essential to discuss these options with a healthcare provider to determine the most appropriate treatment plan.

Frequency and Limitations of Epidural Steroid Injections

While epidural steroid injections can provide significant pain relief, there are limitations to their use, particularly regarding frequency and long-term application.

Key considerations include:

• Number of injections: Most medical guidelines recommend limiting the number of epidural steroid injections to three or four per year.
• Interval between injections: A minimum of two to three months is typically recommended between injections to allow for proper assessment of the treatment’s effectiveness.
• Diminishing returns: Some patients may experience decreased effectiveness with repeated injections over time.
• Long-term risks: Frequent use of corticosteroids can lead to systemic side effects, including bone loss, weight gain, and increased risk of infections.

Healthcare providers must carefully weigh the benefits against potential risks when considering repeated or long-term use of epidural steroid injections. In some cases, alternative or additional treatments may be recommended to manage chronic pain effectively.

Patient Selection and Contraindications for Epidural Steroid Injections

Not all patients are suitable candidates for epidural steroid injections. Proper patient selection is crucial to ensure the safety and effectiveness of the procedure.

Factors that may influence patient eligibility include:

• The specific diagnosis and cause of pain
• The duration and severity of symptoms
• Previous treatments and their outcomes
• Overall health status and any existing medical conditions
• Medications the patient is currently taking

Contraindications for epidural steroid injections may include:

• Systemic infection or infection at the injection site
• Bleeding disorders or use of blood-thinning medications
• Allergy to the injected medications
• Uncontrolled diabetes
• Pregnancy
• Severe spinal stenosis or other structural abnormalities that may complicate the injection

A thorough medical evaluation and discussion with a healthcare provider are essential to determine if an epidural steroid injection is an appropriate treatment option for an individual patient.

Combining Epidural Steroid Injections with Other Treatments

Epidural steroid injections are often most effective when used as part of a comprehensive treatment plan. Combining these injections with other therapies can enhance overall outcomes and provide more sustainable pain relief.

Complementary treatments that may be used alongside epidural steroid injections include:

• Physical therapy: To improve strength, flexibility, and overall function
• Exercise programs: Tailored to the individual’s condition and capabilities
• Medications: Such as oral anti-inflammatories or muscle relaxants
• Lifestyle modifications: Including weight management and ergonomic adjustments
• Psychological support: To address the emotional and mental aspects of chronic pain

The specific combination of treatments will depend on the individual’s diagnosis, symptoms, and overall health status. A multidisciplinary approach, involving various healthcare professionals, can often provide the most comprehensive and effective pain management strategy.

Future Developments in Epidural Pain Management

As medical research continues to advance, new developments in epidural pain management are emerging. These innovations aim to improve the effectiveness, safety, and long-term outcomes of epidural treatments.

Some areas of ongoing research and development include:

• Novel drug formulations: Developing longer-acting or targeted medications to enhance the duration and specificity of pain relief
• Advanced imaging techniques: Improving the accuracy of injection placement and reducing the risk of complications
• Alternative anti-inflammatory agents: Exploring non-steroid options to minimize the systemic effects of corticosteroids
• Regenerative medicine approaches: Investigating the use of stem cells or platelet-rich plasma in combination with epidural injections
• Personalized medicine: Tailoring treatments based on genetic or biomarker profiles to optimize individual outcomes

These emerging technologies and approaches hold promise for improving the management of spinal pain and related conditions. However, further research and clinical trials are necessary to establish their safety and efficacy before widespread adoption.

As the field of pain management continues to evolve, patients and healthcare providers alike should stay informed about new developments and potential treatment options. This ongoing dialogue and collaboration between researchers, clinicians, and patients will be crucial in advancing the field and improving outcomes for those suffering from spinal pain.

All About Epidural Steroid Injections

What Is an Epidural Steroid Injection?

A spinal epidural injection places anti-inflammatory medicine into a specific region of the spine’s epidural space. The medication helps decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs.

“Epidural glucocorticoid injections are commonly given to relieve pain and improve mobility without surgery, buying time for healing to occur or as an attempt to avoid surgery after other conservative approaches failed,” says Leonardo Kapural, MD, PhD.

The epidural injection may help the injury heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury or cause of pain is healing.

“Epidural injections can be a very helpful adjunct in rehabilitation of patient’s the spine pain that radiates into an arm or leg or in the thoracic spine around the chest or trunk,” says Gerard Malanga, MD. “They work by placing cortisone (a potent anti-inflammatory medication) close to an inflamed nerve. This allows the patient to be fully able to regain full motion and increase the muscular support of the spine critical in the recovery and prevention of future episodes.”

“Epidural injections can be done at any level of the spine: cervical (neck), thoracic (mid-back), lumbar (low back), and sacral (tailbone area),” says Steven Richeimer, MD. “The thoracic epidural may be a valuable tool in the treatment of mid-back and chest wall pains. These problems might be caused by disc problems, arthritis of the spine, or even shingles.”

What Is the Spine’s Epidural Space?

The membrane that covers the spinal cord and nerve roots in the spine is called the dura mater, a protective type of tissue. The space surrounding the dura mater is the epidural space.

Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.

Illustration shows many spinal structures including, the third and fourth lumbar (low back) vertebrae, spinal cord, subarachnoid space, and epidural space. Photo Source: 123RF.com.

Types of Epidural Injections

The three types of epidural steroid injections (ESIs) are Interlaminar Epidural Steroid Injection, Transforaminal Epidural Steroid Injection, and Caudal Epidural Steroid Injection. Let’s take a moment to explore each one.

• Interlaminar Epidural Steroid Injection: This injection happens with a person lying face down. Using fluoroscopic X-ray, the surgeon will inject a solution into the epidural space that is causing pain. This procedure is especially useful in the treatment of spinal disorders that affect the entire spine, like spinal stenosis.

• Transforaminal Epidural Steroid Injection: Similar to the Interlaminar Epidural Steroid Injection, the patient is lying face down and the surgeon will use fluoroscopic X-ray to guide the injection. This is a more complicated, but more precise technique than Interlaminar Epidural Steroid Injection. It delivers a small volume of medication to the site of the problem in the spine.

• Caudal Epidural Steroid Injection: This approach, which also uses fluoroscopic X-ray, typically targets the tailbone. It’s therefore often chosen for pain in the lower spine.

Risk of ESIs

Although ESIs have low rates of major risks, there are some potential complications that can occur during the procedure. These include:

• Bone demineralization: Corticosteroids are associated with loss of bone density and future fractures.

• Suppression of the hypothalamic‐pituitary‐adrenal (HPA) axis: This can lead to chronic fatigue syndrome symptoms and, in some cases, Cushing’s Syndrome. High blood pressure, bone loss, and type 2 diabetes can result.

• Suppression of the immune system: This can put you more at risk for infections.

• Elevated glucose levels: This is of particular concern to people with diabetes.

Other complications that can arise from epidural steroid injections include an infection at the injection site, an allergic reaction to the injected solution, nerve injury, numbness in the legs, bleeding, back pain, and, in rare cases, paralysis.

The most important thing you can do throughout the process is to ask questions and communicate honestly and openly about any concerns with your surgeon.

What Happens Before an Epidural?

Although you will be given a local anesthetic during an epidural, some people may receive a mild sedative to help alleviate anxiety about the procedure.

Perhaps the most important preparation you can take is to be mentally ready for the procedure. This means having a thorough discussion with your surgeon about the process, risks, complications. Don’t hesitate to discuss your fears and expectations. The following questions may be helpful in preparing for your ESI:

• Why is the procedure needed?

• What are the alternatives to this procedure? Are there other treatment choices available based on my current medical condition?

• What are the benefits of the surgery, and how long will they last?

• What are the risks and possible complications of having the operation?

• What could happen if I don’t have the operation?

• Should I get a second opinion?

• What is the health care provider’s experience in doing this procedure?

• Where will the surgery be performed?

• What type of anesthesia will be administered?

• What can I expect during recovery?

A few hours before the procedure, the patient may be allowed to eat a light meal. If the patient has type 1 diabetes, they must not change their normal eating pattern before the procedure. Patients may take their routine medications (eg, high blood pressure, diabetic medications).

Patients should not take pain medications or anti-inflammatory medications the day of their procedure. Patients should be in pain before this procedure, so it’s important not to take medications relieve or lessen pain. These medicines can be restarted after the procedure, if they are needed.

If a patient is on Coumadin/warfarin (blood thinner) or Glucophage (metformin, a diabetes medicine), they must notify their treating physician so the timing of these medications can be explained.

In general, the patient is asked to be at the outpatient facility one hour before the procedure and can expect to be at that facility approximately 2-3 hours. A driver must accompany the patient and be responsible for getting them home. No driving is allowed the day of the procedure.

What Happens During a Spinal Epidural Procedure?

An intravenous line (IV) is started so that relaxation medication can be given. The patient is placed lying on their side on the X-ray table and positioned in such a way that the physician can best visualize the low back using X-ray guidance (sometimes called fluoroscopy).

An image of fluoroscopy (real time x-ray) shows what the doctor saw while performing a low back procedure, such as a spinal injection. Photo Source: SpineUniverse.com.

The skin on the patient’s back is scrubbed using two types of sterile scrub (soap). Next, the physician injects a numbing medication into the skin area where the epidural injection will be administered (eg, L3-L4). This medicine stings for several seconds.

After the numbing medicine has been given time to be effective, the physician directs a small needle, using X-ray guidance, into the spine’s epidural space. A small amount of contrast (dye) is injected to ensure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

Pictured is a patient laying face down on their stomach on the treatment table. Pillows help keep the patient comfortable. In the background, is the monitor the physician will view to precisely guide needle placement during the injection procedure. Photo Source: Shutterstock.

What Happens After an Epidural Injection?

The patient is returned to the recovery area where they are monitored by medical staff for 30-60 minutes. Before discharge, the patient is asked to record their levels of pain relief during the next week using a post-injection evaluation sheet (“pain diary”).

A follow-up appointment will be made for a repeat injection pain block, if indicated.

Depending on the patient’s level of pain relief, another injection may be administered in two weeks. The patient’s back or legs may feel weak or numb for a few hours. This is to be expected, but it does not always happen.

Patients may return to their normal activities the day after the procedure, including returning to work.

Effectiveness of Epidural Steroid Injections

Epidural steroid injections are a common non-surgical treatment for several spinal disorders. A wealth of research exists on ESIs, but two specific studies may be of interest.

The first study, published in 2015, focused on the effectiveness of epidural steroid injections on lumbar spinal stenosis symptoms (spinal stenosis affecting the low back is a common cause of back and leg pain).

The study’s authors compared two types of injections: The first contained corticosteroid plus lidocaine, and the second contained only lidocaine. The authors discovered that corticosteroid injections did not provide significant benefit over the lidocaine-only injections. The results questioned the effectiveness of a corticosteroid on symptom relief.

“These results suggest that although certain patient characteristics are associated with greater likelihood of good outcomes following either type of epidural injection for lumbar spinal stenosis symptoms (and possibly of good outcomes regardless of any treatment), there are no currently identified characteristics that predict a differential benefit from corticosteroid,” said Judith Turner, PhD, professor of Psychiatry and Behavioral Sciences and Rehabilitation Medicine at the University of Washington in Seattle.

The second study, published in 2014, questioned whether epidural steroid injections are effective at delaying or preventing spine surgery. While the authors found that the injections provide a short-term benefit—they may prevent the need for surgery for up to a year—the effectiveness isn’t long-term.

“Epidural steroid injections may provide a small surgery-sparing effect in the short term compared with control injections and reduce the need for surgery in some patients who would otherwise proceed to surgery,” the authors wrote.

So, while the injections may prevent or delay surgery, it’s more of a limited benefit than widely thought.

These injections have been shown to provide excellent pain relief in many patients (particularly those who have had symptoms for less than three months, not had a previous spine surgery, are younger than 60, and don’t smoke). However, epidural steroid injections are not magic bullets. Before starting injection therapy, talk to your doctor about the specific risks and benefits for you.

“In my experience, 60% of patients require only one injection and only 10-20% will require three injections,” says Dr. Malanga. “Certainly, if there is little or no pain relief after trying two injections, it is unlikely that the third injection will be of benefit.”

Who is a Candidate For an Epidural Steroid Injection?

These injections do not help every patient.

“For leg pain greater than the back pain, guidelines from a respected source suggest that patients who had full pain relief from the first epidural injection should not receive another one but to be re-evaluated in four weeks and followed thereafter,” says Dr. Kapural.

“Patient selection is very important in deciding on the type of injections patients should receive. Transforaminal injections (different approach to the epidural space) may produce longer pain relief and may also predict whether a patient might benefit from surgery or not. For patients with the diagnosis of lumbar canal stenosis, improvement after such injections may be longer lasting than it was initially thought,” he says.

The first characteristic doctors look for to determine if a person is a candidate for a lumbar ESI is pain that radiates from the lower back into the legs. This can be a result of the following conditions that put pressure on spinal nerves:

• Herniated discs: Vertebral discs that have lost their shape and pushed through the outer layer of the disc

• Degenerative disc disease: Disc degeneration that results in arthritis, in which spine joints begin to wear out

• Spinal stenosis: A condition that causes a narrowing (stenosis) of the spinal canal

• Non-specific radiculitis: Radiating pain without a specific cause

• Vertebral bone spurs: Bony growths on the vertebrae

• Thickening of ligamentum flavum: A type of degeneration of vertebral ligaments

• Postlaminectomy syndrome: Chronic pain after back surgery

• Facet or nerve root cyst: Growths that are most commonly seen in the sacral (pelvic) area of the back

• Post-herpetic neuralgia: Pain caused by shingles

• Compression fracture with radicular pain: A vertebral fracture

• Scoliosis: The curve and rotation of the spine

Keep in mind that these are general categories that may qualify you for ESI. Your health care provider will perform a thorough history and in-depth diagnostic workup to determine whether you are a candidate.

The following conditions could disqualify you from an ESI:

• Systemic infection or local infection at the site of injection

• Significant bleeding issues

• Significant allergic reaction/hypersensitivity to any of the injected materials

• Local malignancy (cancerous tumor)

Notes: This article was originally published February 20, 2000 and most recently updated November 30, 2022.

Patel, K., Chopra, P., Upadhyayula, S. “Epidural Steroid Injections.” [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022, https://www.ncbi.nlm.nih.gov/books/NBK470189/

Katz, J.N., Zimmerman, Z.E., Mass, H., et al. “Diagnosis and Management of Lumbar Spinal Stenosis: A Review.” JAMA, 2022, https://jamanetwork.com/journals/jama/fullarticle/2791689?resultClick=1

“Ligamentum flavum. ” Radiopedia.org, https://radiopaedia.org/articles/ligamentum-flavum?lang=us

Chokshi, F.H, Quencer, R.M., Smoker, W.R.K. “The ‘Thickened’ Ligamentum Flavum: Is It Buckling or Enlargement?” American Journal of Neuroradiology, 2010, http://www.ajnr.org/content/31/10/1813

Oh, Y., Shin, D.A., Kim, D.J., et al. “Effectiveness of and Factors Associated with Balloon Adhesiolysis in Patients with Lumbar Post-Laminectomy Syndrome: A Retrospective Study.” J Clin Med, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230941/

“Tarlov Cyst.” American Association of Neurological Surgeons, 2022, https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Tarlov-Cyst

“Questions to Ask Before Surgery.” Johns Hopkins Medicine, 2022, https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/questions-to-ask-before-surgery#:~:text=This%20will%20allow%20you%20to,against%20the%20risks%20before%20surgery.

“Epidural Steroid Injections (Interlaminar, Caudal and Transforaminal). ” Johns Hopkins Medicine, 2022, https://www.hopkinsmedicine.org/sibley-memorial-hospital/patient-care/pain/treatments.html

Van Boxem, K., Rijsdijk, M., Hans, G., et al. “Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group.” Pain Pract, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379698/#papr12709-bib-0013

Our Review Process

Epidural – NHS

An epidural is an injection in your back to stop you feeling pain in part of your body.

This page covers epidural anaesthesia, a type of epidural commonly given for pain relief in childbirth and in some types of surgery.

When epidurals are used

Epidurals can be used:

• during labour and childbirth, including caesareans
• during some types of surgery
• after some types of surgery

Steroid medicine can also be given with an epidural injection, to treat pain in your back or leg that’s caused by sciatica, or a slipped (prolapsed) disc.

Preparing for an epidural

If you have any concerns or questions about having an epidural, discuss these with your doctor. Let them know about any medicines you’re taking.

You may be given specific advice about eating, drinking and medicines before the epidural.

You will not be able to drive for 24 hours after having an epidural, so you’ll need to arrange for someone to take you home.

How an epidural is given

Epidurals are given by a specialist doctor called an anaesthetist.

You’re usually awake during an epidural, but for some types of surgery you may have it while under general anaesthetic.

• A drip will be placed in your arm so you can be given fluids while you’re having the epidural.
• You’ll be asked to sit down and lean forwards, or lie on your side with your knees up close your chest.
• You’ll be given an injection of local anaesthetic to numb the skin where the epidural will be inserted.
• A needle is used to insert a fine plastic tube called an epidural catheter into your back (spine) near the nerves that carry pain messages to your brain.
• The needle is then removed, leaving just the catheter in your spine.
• You may feel mild discomfort when the epidural needle is positioned and the catheter is inserted.

The epidural can be inserted at different levels of your spine, depending on the area of your body that needs pain relief.

Pain relief medicines are then given through the catheter. These take about 20 to 30 minutes to take full effect.

Your chest, tummy and legs may feel numb while the epidural medicines are being used, and your legs may not feel as strong as usual.

While the catheter remains in your back, it can be used to top up your pain relief medicines manually or using an automatic pump.

This can be for several hours (during childbirth) or for a few days (after major surgery).

Mobile epidurals, which use a lower dose of pain relief medicines, are sometimes used in childbirth, allowing you to walk around during labour.

Recovering from an epidural

When the epidural is stopped, the numbness usually lasts for a few hours before its effects begin to wear off.

While the medicine wears off, you’ll probably be advised to rest in a lying or sitting position until the feeling in your legs returns.

This can take a couple of hours, and you may feel a slight tingling sensation in your skin.

Tell the doctor or nurse if you feel any pain. They can give you medicines to help control it.

Do not drive, operate machinery or drink alcohol for 24 hours after having an epidural.

Risks and side effects of an epidural

Epidurals are usually safe, but there’s a small risk of side effects and complications, including:

• low blood pressure, which can make you feel lightheaded or nauseous
• temporary loss of bladder control
• itchy skin
• feeling sick
• headaches
• nerve damage

Read more about the side effects and complications of an epidural

Page last reviewed: 01 February 2023
Next review due: 01 February 2026

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Dear patients!
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How is epidural anesthesia done and how long does it last? – Ropisthesia

The choice of anesthesia method is one of the most pressing issues in preparing for childbirth. Epidural anesthesia is recognized as the most effective method. It allows you to significantly facilitate the course of childbirth, improve the well-being of the woman in labor and save strength to meet the baby. At the same time, epidural anesthesia does not block motor activity, does not affect consciousness: a woman has the opportunity to fully participate in childbirth and follow all the doctor’s recommendations.

Additional benefits of epidural anesthesia:

• The doctor can control the dosage of , the strength and duration of pain relief thanks to the epidural catheter.
• Safety for mother and baby . If the drug is chosen correctly, and the introduction is performed correctly, epidural anesthesia does not harm the woman in labor and the baby.
• Help in labor activity. After the introduction of epidural anesthesia, normalization of uterine contractility, relaxation of the pelvic muscles, and accelerated opening of the cervix are observed.

Given these positive aspects, in the developed world, 60 to 90% of women give birth with an epidural. Therefore, the myth that such a procedure disrupts the birth process should be left in the past. There is no reason to experience pain and stress while giving birth in a modern hospital environment and under the supervision of qualified medical personnel.

How an epidural is done: a description of the procedure

The procedure for performing epidural anesthesia is shrouded in many myths. Therefore, some women find it long, scary and very uncomfortable. It is the fear of this method of anesthesia that often makes women in labor refuse epidural analgesia. But in fact, the technique of epidural anesthesia is understandable and safe. The whole process takes about 10 minutes. You will not experience severe pain during the insertion of the catheter because the skin is pre-treated with a local anesthetic such as lidocaine.

The procedure for epidural anesthesia is as follows:

• The woman should sit down and lean forward or lie on her side in a comfortable position. It is important not to move while inserting the catheter, so keep your body in one position.
• The skin at the catheter insertion site is pre-treated with a local anesthetic to reduce pain during insertion of the epidural needle.
• The anesthesiologist inserts through a thin needle tube (catheter) into the epidural space. This is done in between contractions.
• Pain medication is administered. After 20-30 minutes you will feel the effect of pain relief. Epidural anesthesia can be administered in stages (small doses) or once – the entire drug at the same time. While the catheter is in the epidural space, it can be used to replenish medication manually or with an automatic pump.

After delivery, the doctor removes the catheter from the woman’s back, but it is recommended to remain still for 2-3 hours after the epidural. The catheter may remain in the epidural space for as long as required and may last from a few hours (during labor) to several days.

How long does an epidural last?

Many women in labor worry that the epidural will wear off too quickly and they will continue to experience severe pain. But in fact, such a situation is impossible. Since during childbirth there is an anesthesiologist in the delivery room who constantly monitors the patient’s condition and is ready to take all necessary actions, in particular, to administer another dose of painkillers.

Generally speaking, the effect of the first dose of epidural anesthesia expires no earlier than 2 hours after administration. As we noted above, you can enter a new dose of medication for the entire period of time while the catheter is in the epidural space. Therefore, if you need more pain relief, the anesthetist will take care of it.

Ropisthesia – your comfortable birth

Don’t endure the pain and stress of childbirth. After all, modern medicine offers safe, effective and long-term methods of pain relief that do not harm the mother and baby.