A lumbar epidural is a procedure often used to relieve inflammation in the nerve roots at the base of the spine. It is called an epidural because it requires the injection of anti-inflammatory medication into the space around the dura membrane, or membrane surrounding the nerve roots and spinal cord. Inflammation of nerve roots in the lower, or lumbar, spine can lead to pain in the legs and back. A lumbar epidural can be used to relieve pain, reduce inflammation, and allow an injury to the lumbar nerve roots to heal.
A lumbar epidural is typically performed as an outpatient procedure. Patients are usually placed in a reclining position, and may be given sedative medication intravenously during the procedure. Doctors may use X-ray guidance to ensure that they are injecting the medication in the appropriate place.
In general, doctors use a combination of steroid medications, such as cortisone, and anesthetics to perform a lumbar epidural. These medications are injected directly into the epidural space, or the space that surrounds the dura membrane of the spine. Patients are normally asked to remain in a reclining position, under medical supervision, for up to one hour after the procedure is complete. If the patient experiences no weakness in the legs, he may be discharged at this time; otherwise, he may remain under supervision for up to three hours until leg strength returns. While most patients can return to normal activities, including work, the next day, they are advised to rest and refrain from driving for at least 24 hours after receiving the epidural.
This procedure may provide a few hours of immediate relief from pain symptoms, due to the anesthetic in the injection. The steroid medications injected during this procedure, however, may not take effect for up to one week. Patients may receive more than one lumbar epidural injection. Multiple injections may be administered every two to three weeks. Most patients may not receive more than three injections in any six-week period.
Patients are generally prohibited from using any other pain relief medications on the day they receive a lumbar epidural, so that they can accurately gauge the procedure's effectiveness. Patients may take other medications, and are usually advised to eat a small meal within a few hours before the procedure. Insulin-dependent patients are normally warned not to change their normal eating and insulin schedule on the day of the procedure. Insulin-dependent patients should ideally discuss their use of prescription medications with the doctor performing the procedure, so that he can schedule the epidural to avoid interactions with any diabetes medications.