Caudal Epidural

Patient Information

What is an epidural injection?

An epidural is the name given to an injection into the epidural space. This lies between the vertebrae (backbones) which form the walls of the spinal canal, the spinal cord and the nerves that lie within it.

Epidural injections are widely used in the treatment of chronic neck and back pain. The injection can be performed at any level within the spine.

A Caudal epidural is at the base of the spine.

How does it work?

The injection given contains a mixture of local anaesthetic and local steroid. It is thought to have three beneficial effects:

A physical action, increasing the space around compressed nerves.

Local anaesthetics numb the nerves for a period of hours, giving short term pain relief.

The steroid has a long term effect reducing inflammation around the nerves.

There are only minimal effects on the rest of the body using local steroids by this route of administration. Any side effects are most likely to occur if steroids are given frequently over a short period of time, for example raised blood pressure and weight gain. Diabetics may experience short-term problems with blood sugar level control.

If the epidural is helpful it may be repeated at the discretion of your pain consultant.

An epidural injection is performed as a day case procedure. On the day of treatment please take all routine medication. If you are taking any medications to thin blood such as Warfarin, or you have a blood clotting disorder, please inform the pain doctor or the Chronic Pain Nurse as soon as possible as your medication may need to be stopped for 48 hours.

Please have a light breakfast only before your admission on the day of treatment.

Shortly before the epidural you will need to change into a hospital gown. You will be seen on the ward by one of the chronic pain Doctors who will ask you to sign a consent form for the treatment.

Prior to the injection you may have a cannula (needle) placed in the back of your hand to allow access to a vein.

For a lumbar or thoracic epidural you will be asked to sit on the table with your legs resting on a stool and asked to lean forwards slightly, after the injection you will lay down in a position that is comfortable to you.

For a cervical or caudal epidural you will lie on your front, after the injection you can turn over into a comfortable position, if you have difficulty moving a member of staff will be there to help you.

The skin on your back will be cleaned with antiseptic and a local anaesthetic injected into the skin to help numb the area. There may be some discomfort in the back at the time of the injection.

You will have a small dressing on your back or neck to cover the procedure site this may be removed after 24 hours but do not worry if it should fall off sooner.

You may sleep in any position that you find comfortable.

Do not drive, operate machinery or drink alcohol for 24 hours following your injection.

What are the side effects?

For procedures performed above the waist you may feel some tingling or reduced sensations in your arms, this is normal, and these sensations will improve after 24 to 72 hours. There may be some weakness in the arms and hands, the weakness will improve but until full sensation returns you must avoid lifting and take extra caution when handling hot drinks.

For procedures below the waist you may feel some tingling or reduced sensation in your legs, this is normal and will improve after 24 to 48 hours. An epidural may numb the stomach area including the bladder. There may be loss of bladder sensation or slight urinary incontinence following the procedure, the sensation will return to normal as soon as the numbness wears off.

It is not unusual to experience a burning sensation in the affected limbs for up to 1 week after the epidural. You may have increased pain in your back or neck and or the affected limbs this is normal and will improve over the period of a few days. Some patients may experience a headache following an epidural, if you do have a headache this will improve with rest and your normal analgesics.

It is important that you have a responsible adult to escort you home and stay with you overnight. You must not drive or use public transport for the journey home. It is recommended that you rest for the remainder of the day.

If the epidural helps to reduce the level of your pain, please remember that it is not a cure and you will still have a problem with your neck or back. Do not rush about doing strenuous activities, but build up your activity levels slowly.

If you have any questions please contact the Pain Management Help Line (answer phone) on Telephone: 01942 7 7 3 1 3 9

Research

Research is undertaken to add to the existing scientific knowledge on a particular subject. There are a number of staff within the Trust who conduct Research studies. It is possible that during the course of your treatment you may be asked to take part in a research study, however, you do have the right to refuse, and this will not affect the care that you receive.

Your NHS Number, Keep it Safe.

Every person registered with the NHS in England and Wales has their own unique NHS Number. It is made up of 10 digits for example 1 2 3 4 5 6 7 8 9 0.

Everyone needs to use the NHS Number to identify you correctly. It is an important step towards improving the safety of your healthcare.

Always bring your NHS number with you to all hospital appointments or quote it if you need to telephone the hospital for any enquires. This will allow staff to check that they have the right patient details by checking this against your NHS number.

To improve safety always check your NHS Number on correspondence the NHS sends to you.

Ways of finding out your NHS Number

If you do not know your NHS number, contact your GP or local Primary Care Trust. You may be asked for proof of identity, for example a passport or other form of identity this is to protect your privacy.

Once you have obtained your NHS Number write it down and Keep it Safe

Data Protection

The Trust will endeavour to ensure that your information remains secure and confidential at all times. The Data Protection Act 1998 explains how personal information should be processed and this applies to all information whether held on paper or electronically on computer systems. We must ensure that all personal information is processed fairly, lawfully and as transparently as possible so you:

Understand reasons for us processing your personal information

Give your consent for the disclosure and use of information where necessary

Gain trust in the way we handle your information

Understand your rights regarding the right to request access about the information we hold about you.

The Caldicott Guardian, who is a senior health clinician, has the role to ensure we meet the highest standards for handling personal information at the Trust.

For further information regarding data protection, please read our leaflet called “Protecting Your Data - How we use your health records” or visit the Information Governance pages on the Trust website.

Patient Relations

The Patient Relations Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. We will do our best to help you to resolve any concerns you may have about the care you received. We can also give you information on the services provided by the Trust.

If you have a concern or there is a problem, the best way to get it resolved is usually to tell someone there and then. On a ward, talk to the sister or charge nurse on duty. In a clinic, talk to the receptionist or one of the nursing staff. If you want to talk to a senior manager or to someone who has not been directly involved in your care and treatment, we can usually arrange this during office hours. You can also ask to speak to a member of the Patient Relations Department.

Staff in any ward or department will be able to contact a member of the team for you or you can telephone 01942 8 2 2 3 7 6. The Patient Relations Department is open Monday to Friday between 9:00 am and 4:00 pm. Outside of these hours there is an answer-phone service.

If you wish to make a formal complaint you can telephone or write to:

The Patient Relations Manager

Wrightington Wigan and Leigh NHS Foundation Trust

Royal Albert Edward Infirmary

Wigan Lane

Wigan WN1 2NN

Telephone: 01942 8 2 2 3 7 6

This leaflet is also available in audio, large print, Braille and other languages upon request.

For more information call 01942 7 7 3 1 0 6.

© Wrightington, Wigan & Leigh NHS Foundation Trust 2008

All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner

Dial 0845 4 6 4 7 for NHS Direct health advice and reassurance

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