Having a Thoracic Epidural Injection
A thoracic epidural injection is a shot that helps ease pain in your upper to middle back (thoracic) area. Medicine is injected into the area around your spinal cord.
What to tell your healthcare provider
Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as ibuprofen. It also includes vitamins, herbs, and other supplements. And tell your healthcare provider if you:
Have had any recent changes in your health, such as an infection or fever
Are sensitive or allergic to contrast dye
Are sensitive or allergic to any medicines, latex, tape, or anesthesia (local and general)
Are pregnant or think you could be
Tests before your procedure
You may need other tests before you get the injection. For example, you may have an MRI scan of your upper to middle back area.
Getting ready for your procedure
Talk with your healthcare provider how to get ready for your procedure. You may need to stop taking some medicines before the procedure, such as blood thinners and aspirin.
Also, make sure to do the following:
Ask a family member or friend to take you home from the hospital.
Don't eat or drink for several hours before your procedure.
Follow all other instructions from your healthcare provider.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully. Ask questions if something is not clear.
On the day of your procedure
You may have the procedure at the hospital, a surgery center, or a clinic. A pain specialist, radiologist, or other type of specialist may do the procedure. Your healthcare provider can tell you exactly what to expect. In general:
You may be given medicine to make you feel relaxed and sleepy (sedation).
You will lie on your belly (abdomen) or on your side on a special table.
The healthcare provider will clean the skin on your back in the area of the injection.
He or she will inject some medicine to numb the area (local anesthetic).
The provider will use special X-ray (fluoroscopy or CT scan) to put the needle into the correct area.
He or she will inject contrast dye to make sure the needle is in the epidural space.
He or she will slowly inject medicine. It is usually a mix of anti-inflammatory medicine (steroid) and numbing medicine (anesthetic). You may feel slight discomfort and pressure.
Once done, the provider will remove the needle. He or she may cover the injection site with a small bandage.
The steroid medicine lessens swelling and nerve irritation. The anesthetic medicine numbs the area.
After your procedure
After the procedure, you will be moved to a chair or bed to rest for a while. The healthcare staff will watch you for any problems. You should be able to go home in an hour or so. Make sure you follow all instructions from your healthcare provider and the staff. You may be told to do the following:
Rest for the remainder of the day, and go back to your normal activities the next day.
Don't drive or make any important decisions for at least 24 hours, if you had sedation.
Expect some numbness in your arms that will go away within a few hours.
Recovering at home
You may not notice any improvement right after the injection. You may even feel a little worse afterward. It may take a few days to a week until your pain lessens. The pain relief may last for weeks or months. Or the pain may not return at all.
You’ll have an appointment with your healthcare provider in 1 to 2 weeks to discuss:
If the injection has lessened your pain
If you need additional injections
Other treatment you may need, such as exercises, medicines, and physical therapy
When to call your healthcare provider
Call your healthcare provider right away if you have any of these:
Fever of 100.4°F (38.0°C) or higher
Numbness at the injection site that doesn’t go away
Warmth and redness at the injection site, or in your arms, that doesn't go away
Pain that is getting worse
September 01, 2017
Chou R. Subacute and chronic low back pain: nonsurgical interventional treatment. UpToDate., Cohen SP, Bicket MC, Jamison D, Wilkinson I, Rathmell JP. Epidural steroids: a comprehensive, evidence-based review. Reg Anesth Pain Med. 2013;38(3):175-200., Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and adviseations. Pain Physician. 2013;16(2 Suppl):S49-S283.
Fraser, Marianne, MSN, RN,Moe, Jimmy, MD