Epidural injection (epidural block)

A natural solution for your spine!

What is an epidural injection?

An epidural injection (also called an epidural block or an injection into the epidural space) is a minimally invasive painrelief procedure in which medication - usually a combination of a corticosteroid and a local anesthetic - is administered into the epidural space of the spine, close to the nerve roots.

The goal of the procedure is to reduce inflammation, swelling, and pain originating from compressed or irritated nerves, for example in the setting of a herniated disc.

Before the procedure is performed, the patient undergoes a thorough qualification process to confirm that the pain indeed originates from the spine and nerve roots.

The qualification process includes:

Detailed medical interview

The doctor evaluates:

  • the character, location, and intensity of the pain,
  • its duration, and factors that worsen or relieve it,
  • previous treatments (medications, physiotherapy, procedures).

Physical examination

This includes assessment of:

  • spinal mobility,
  • presence of radicular symptoms (pain, numbness, muscle weakness),
  • neurological and orthopedic tests.

Imaging tests

MRI or CT scans of the spine help identify the source of pain (for example a disc herniation, spinal canal stenosis). The results of these tests help determine exactly which spinal level requires treatment.

General health assessment

This includes:

  • evaluation of comorbidities,
  • exclusion of contraindications (e.g., bleeding disorders, infection, drug allergies).

Discussion of the procedure with the patient

The doctor explains how the procedure is performed, its potential effects, and risks. The patient signs informed consent.

Why is the qualification (preprocedure assessment) so important?

  • It enables the physician to select the correct spinal level and the most appropriate injection technique.
  • It increases the effectiveness and safety of the procedure.
  • It helps avoid unnecessary interventions when the pain originates elsewhere.
  • It gives the patient a clear understanding of the procedure’s purpose and expected outcomes.

Main indications for an epidural block

Disc herniation (discopathy)

Pressure exerted by a disc protrusion on a nerve root causes pain radiating to the limb (known as sciatica). An epidural injection reduces inflammation and swelling around the nerve and provides relief.

Spinal canal stenosis

Narrowing of the spinal canal leads to nerve compression, often presenting with pain on walking, numbness, and a feeling of heaviness in the legs. An epidural block can decrease pain and improve exercise tolerance.

Lumbosacral spine pain syndrome

Chronic lowerback pain, often with an inflammatory component. When rehabilitation and medications are insufficient.

Posttraumatic and postoperative spinal pain

Pain after injury or spinal surgery or in the context of degenerative changes. An epidural block can reduce pain and facilitate earlier rehabilitation.

Neuralgic pain syndromes

Chronic nerve pain stemming from irritation of the spinal nerve roots.

Effect of an epidural block

An epidural injection aims to reduce pain, inflammation, and swelling around compressed or irritated spinal nerves. By administering a corticosteroid (antiinflammatory) together with a local anesthetic, the procedure provides targeted and often longlasting pain relief.

The analgesic effect may include:

  • Reduction of pain radiating to the limb.
  • Improved spinal mobility.
  • Decreased paraspinal muscle tension.
  • Better sleep quality and everyday functioning.

Stages of the procedure

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STEP 1 – Patient preparation

The patient is informed about the procedure and provides consent.

The skin at the injection site is disinfected.

STEP 2 – Local anesthesia

The doctor injects a small amount of local anesthetic into the skin and subcutaneous tissues to minimize discomfort during the next steps.

STEP 3 – Needle insertion under Xray guidance

A special needle is inserted between the vertebrae, through the ligamentum flavum, into the epidural space.

Why is Xray guidance so important?

• It provides precision, ensuring the needle reaches the epidural space accurately.

• It guarantees safety, minimizing the risk of accidental damage to neural structures or blood vessels.

• It allows continuous monitoring of needle placement and spread of the medication.

  • • It increases the clinical effectiveness of the procedure.

STEP 4 – Medication administration

The doctor slowly injects the medication (e.g., a local anesthetic and/or a corticosteroid).

STEP 5 – Needle removal and dressing

The needle is removed and the injection site is covered with a sterile dressing.

The patient is observed for several minutes up to an hour to ensure no adverse reactions occur.

Clinical notes

An epidural block is a minimally invasive and safe procedure, performed under local anesthesia with Xray guidance, which ensures high precision and minimizes the risk of complications. After a short period of observation, the patient can usually leave the clinic.

Rest after the procedure

Rest for 1–2 hours after the injection. For the first 24 hours, avoid physical exertion. During the following 3–5 days, avoid:

  • heavy lifting,
  • bending,
  • intense physical activity or sudden movements.

Driving is safe once any temporary weakness or numbness has resolved - usually the next day.

Normal reactions after the procedure

You may experience:

  • a sensation of numbness, tingling, or warmth in the limb or spinal area,
  • mild pain or tenderness at the injection site,
  • a temporary increase in pain during the first 24 hours,
  • slight dizziness or a feeling of weakness—these usually pass quickly.

The full effect of the steroid may appear after 3–7 days, and sometimes only after 10–14 days.

You can usually continue your regular medications unless your doctor advises otherwise.

When to contact a doctor urgently

Seek immediate medical attention if you develop:

  • fever or chills,
  • increasing pain or swelling at the injection site,
  • severe headache that worsens when standing (may indicate cerebrospinal fluid leakage),
  • sensory or motor disturbances in the limbs,
  • micturition disorders or impaired defecation,
  • allergic symptoms (rash, shortness of breath).