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Why might I need a Caudal Epidural?
You have a damaged and inflamed intervertebral shock-absorbing disc in your lower back, causing pain in your back and perhaps into the buttocks, or running down into your leg(s).
When the disc is inflamed, the nearby nerves become irritated and you experience pain. New nerves can grow around the back of the disc, increasing sensitivity to pain. Sometimes the nerves that supply the sensation to the leg (Sciatic) are affected and hence, the brain is fooled into believing that the leg is injured. But, this is not the case; the problem is in the spine. Often movement is reduced due to secondary muscle spasm. This is the body’s natural response to try and ‘protect or defend’ the spine while it tries to heal. However, if the spine cannot ‘heal itself’ then this spasm becomes unhelpful and indeed part of the problem.
Are there any risks with a Caudal Epidural?
An epidural is a very commonly performed procedure but as with all medical procedures there are some risks. Complications that are minor and occur quite frequently include:
- Bruising of the skin and under the surface.
- A fall in blood pressure. This can easily be corrected by using a drip and giving fluid to the patient, or by giving specific drugs.
- Feelings of nausea or sickness. These can be treated with anti-sickness drugs.
- Mild to moderate discomfort. This can normally be treated by giving small doses of painkillers via a drip.
- A feeling of heaviness and difficulty in moving the legs. This very occasionally happens but wears off over a few hours. In a tiny minority of cases, you may need to be kept in hospital overnight.
- Difficulty passing urine. Rarely, the nerves that control the bladder may stop working temporarily. Again this normally goes away after a few hours. When this happens, a small number of people will need to have a tube passed into the bladder to drain the urine. The bladder does recover in a short time and there is no permanent damage.
- Severe headache. If the epidural needle causes a leak of the fluid around the spinal cord, a severe headache can result. The chance of this happening is about 1 in 10,000. A headache would mean that you are required to stay in the hospital for treatment for perhaps several days. There are usually no long-lasting problems from this.
- It is possible that all or part of the injection may accidentally go into a vein. If this happens you may feel dizzy, light-headed, sick or faint.
- Difficulty breathing. Sometimes the epidural block solution can enter the fluid around the spinal cord and affect the nerves that supply breathing. This is rare and injecting dye first, to ensure correct needle position, usually prevents this from happening. Stopping the epidural and sitting the patient up is normally all that is needed to resolve this problem. During this time, extra oxygen may be given to you by a mask.
- A blood clot can form in the spinal canal due to a puncture of a vein. This is extremely uncommon. However, if this occurs, this may need to be surgically removed.
- Infection. It is extremely uncommon but sometimes an abscess may form in the spinal canal, which may need an operation to remove it.
- Pain. Sometimes patients complain of worsening of their pain, or a new pain. It is difficult to explain this as there is rarely anything new to find on examination.
- You may suffer an allergic reaction to any of the medications.
- Nerve damage and weakness.
- The injected steroid or cortisone may cause disturbance of other body hormones.
How to prepare for a Caudal Epidural
Your consultant will provide you with all the relevant information before your procedure, along with any preparation you may need to do in the days leading up to your surgery. It is important to tell your consultant about any medicine you may be taking, including any over the counter pain medicine such as paracetamol or aspirin.
You may need radiological (imaging) tests before your procedure, including ultrasound, x-ray or an MRI scan.
Do not eat (this includes chewing gum) or drink for six hours before you are due to have surgery, otherwise, your surgery may be delayed or rescheduled.
Please ensure you have a competent adult available to take you home after you leave OneWelbeck Orthopaedics.
What will happen during my procedure?
An anaesthetist will discuss the type of sedation used and the process they will follow with you. This procedure will not require a full general anaesthetic (GA). However, a local anaesthetic (LA) technique enhanced with intravenous pain relief and sedation will be employed where appropriate. You will be given the opportunity to ask any questions and raise any concerns you may have with your anaesthetist.
Once in the theatre suite, you will be connected to some monitoring equipment to measure your heart rate, blood pressure and the oxygen content of your blood. A needle or ‘drip’ will be placed in a vein, usually in the back of the hand. Then, you will be asked to lie face down on your tummy. Being in a comfortable position is very important when this procedure is done.
When this is achieved your back will be cleaned with an antiseptic solution, and some local anaesthetic will be introduced into the skin. When the skin has gone numb a needle will be introduced into the back very slowly and carefully. Once the needle is in the correct place in the epidural space, a single dose of medication will be injected and then the needle will be removed.
When the injections are completed, you will then be positioned in a way to make you as comfortable as possible.
What happens after procedure?
After your procedure, you will be carefully supervised by your dedicated nurse at OneWelbeck Orthopaedics. And once you have seen your Consultant, you will be able to go home the same day. It is important to rest to allow the best chance of healing.
Make sure you follow any advice given to you by your consultant including any advice on pain relief and any exercises you may be given.