Caudal Epidural Injection Orthopaedic Department

Caudal Epidural Injection
Orthopaedic Department
Patient Information Leaflet
Originator: Ann Flavell
Date: July 2012
Version: 3
Date for Review: July 2015
DGOH Ref No: DGOH/PIL/00701
Introduction
Welcome to The Dudley Group NHS Foundation Trust. This leaflet
will provide you and your relatives with information about caudal
epidural.
What is a caudal epidural?
This is an injection given into the very base of your spine, close to
your coccyx (tail bone). The Epidural Injection consists of local
anaesthetic (medication to temporarily numb the nerves) and a
steroid (anti-inflammatory medication). Both act towards blocking
the pain signals sent to the brain and the steroid reduces localised
swelling and inflammation which may be putting pressure on the
nerves and causing some of the pain you are experiencing.
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Useful contact numbers or website details
The benefits of the injection
Faculty of pain medicine www.rcoa.ac.uk/fpm
British pain society www.britishpain
Royal college of physicians
Royal college of anaesthetist's
This injection is most commonly given to people who have pain
across the lower back and buttocks with some spread into the
hip(s) and leg(s). The local anaesthetic acts on the nerves and
temporarily blocks their function. The steroid decreases
inflammation and improves the chances of longer term pain relief.
The pain relief may take days or weeks to take effect and may not
provide 100% relief.
If you have any concerns / problems please contact:
Russells Hall Hospital
Day Surgery Unit
Tel: 01384 45611 ext 3578/4700
Russells Hall Hospital
Pre-assessment Unit
Tel: 01384 456111 ext 1656
What are the alternatives to the injection?
Other treatments include analgesia, anti-inflammatory medications
and sometimes physiotherapy.
Risks of the procedure
The injections do not work for everyone, unfortunately this cannot
be predicted.
Side effects of the injection
You may experience some pain around the injection site
Your pain may increase. This is usually short lived and easily
controlled with painkillers
You may have some local bruising and tenderness on your
skin
A feeling of "heaviness in your legs" may occur, this will
resolve after a short period of time
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The local anaesthetic can temporarily numb the nerves that
control your blood pressure. The decrease in blood pressure
can make you feel lightheaded and unsteady on your feet.
This is easily remedied by lying down
Headaches - due to the leakage of CSF (cerebrospinal fluid)
Temporary bladder leakage in those with weak pelvic floor
muscles - usually wears off in 2-4 hours
Rare side effects include
Infection
Nerve damage
Bleeding and haemorrhage into the epidural space
Side effects of the steroids
There are very few side effects associated with single or occasional
use of steroid injections. These normally resolve within a few days.
Mild side effects include:
Hot flushes, feeling sick , mild abdominal pain
Temporary increase in your sugar levels (diabetics)
Temporary alterations in menstrual cycle (females)
Pre-operative assessment
Please inform us if you are diabetic, have a cough or cold or have
any kind of infection.
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The next day you will need someone at home to help you, so you
do as little as possible, but you do not have to stay in bed.
Start simply by taking two walks a day but keep it to a distance you
know you can manage. Avoid overdoing things too soon.
You may have recommended exercises by a physiotherapist
If you can try swimming once or twice a week using front crawl or
backstroke as this is easier on your back. By doing these
suggested exercises, you will allow your back muscles to regain
some of the lost strength and help them support your
spine.
If you do not strengthen your back muscles, any benefit from the
epidural will be very short-term, as it is not a cure in itself, only a
form of symptom management.
Expect to have a follow up appointment with the consultant or
crthopaedic practitioner 4 to 6 weeks after your epidural. You may
be referred for physiotherapy if you are already having treatment.
Seek medical advise if you experience any complications at home
such as:
Headache
Fever
Prolonged numbness and or weakness to lower limbs
Unable to pass urine
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Once you have had something to eat and drink you will be
allowed to get up. Prior to discharge you will be assessed for
any numbness and / or weakness in your legs. You will be
asked if you have a headache and checked that you have
passed urine.
If you are comfortable and have recovered from the procedure
you will be allowed to go home
You must not drive home or go home on public transport. Please
arrange for someone to collect you from the day case unit. Please
ensure that you have an adult to stay with you for 24 hours.
Your discharge Nurse will provide you with a letter for your
GP, a sick note (if required) and any medication that you have
been prescribed
You will be given instructions on when to remove the plaster
from the injection site. (Usually 24 hours after the procedure)
Your follow up appointment will be sent to you by post
Aftercare advice
Returning to work depends upon the type of job that you do. It is
advisable that you do not return to work until the initial discomfort
has settled. Continue to take your pain tablets till you notice any
improvement in your symptoms.
If possible, you should go home and rest for the remaining part of
the day.
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You must inform us if you are taking any of the following tablets antibiotics, any blood thinning medication such as aspirin, warfarin
or clopidogrel as some of these may need to be stopped for a short
period of time prior to the procedure.
Information for females - We will need to know the start date of
your last menstrual period due to the use of x-ray equipment. If you
think you may be pregnant, please let us know.
You may be asked to undergo some investigations
- Blood tests, if you take certain medications
- An ECG may be performed depending on your age and
medical history
If you need to be treated as an inpatient you will also need to have
swabs taken for Methicillin Resistant Staphylococcus Aureus
(MRSA). The pre-assessment staff will give you more information
about this.
What to do if you become ill before your
procedure?
It is important that you inform the day case unit or pre-operative
assessment unit if you are not well enough to attend for the
procedure. For example any type of infection such as a cough or
cold, or chest infection. Any skin problems such as rashes,
abrasions or cuts to the skin near where the injection will be
inserted may prevent the procedure taking place.
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Important information.
If you\'re injection is arranged by the Orthopaedic Assessment
Service (OAS) this will be carried out without sedation. Therefore
you may eat and drink as normal. If your injection has been
arranged by your Consultant in clinic, you will be informed whether
it is necessary to withhold food and drink prior to your procedure.
Your admission to hospital letter will provide clear instructions on
fasting if necessary.
Admission to day case unit
If you are attending the day case unit please bring a dressing
gown, slippers and any medication you are currently taking.
What will happen when I get to the day case
unit?
When you arrive you will be shown to your bed
A member of staff will prepare you for your procedure by
completing your theatre checklist. These questions ensure
that you understand your planned procedure and that you are
prepared for the procedure. During this checking you will be
informed of the approximate time of your procedure. You will
be asked to undress and put on a theatre gown
You will be escorted to theatre by a member of the theatre
team
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How is this carried out
The procedure is carried out in theatre, as a day case .You will be
awake whilst it is performed but you may be offered an injection
into the back of your hand to help you to relax (sedation).You will
be asked to lie on your stomach with a pillow under your tummy.
The area over the coccyx will be cleaned with an antiseptic
solution, which may feel a little cold. Sterile sheets will then be
placed around the area which is to be injected.
Local anaesthetic will be injected into the area, this may sting but
the discomfort will only last a few seconds. Whilst the procedure is
being carried out you may feel some pushing or pressure but
should have no pain, if you do feel any discomfort, then please let a
member of the theatre team know. It is not unusual to feel pressure
in your head whilst having the epidural, if you find it too
uncomfortable then please tell a member of the theatre team.
Once the procedure has been completed, you will be returned to
the ward area.
After the procedure
Your blood pressure and pulse will be monitored
You will be asked to lie on your front if possible for about an
hour
If you have any pain, oral pain relief can be given. Please
inform a member of the nursing staff if you have any pain
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