Sacral Epidural Injections

What is Sacral Epidural /Caudal Epidural Injection?

A Caudal Epidural injection is administered at the lower part of the spine close to the tailbone. Within the spinal column lies the epidural space, where the spinal cord and nerves are enclosed in a thin, dural membrane filled with fluid. The objective of an epidural injection is to disperse the medication around the outer layer of this membrane.

Why is it done?

Epidural steroids and long-acting local anaesthetic medication are administered to alleviate nerve pain in the legs.

It is important to note that although epidural injections may not effectively relieve back pain, they can be used as a treatment option for leg pain. The solution injected contains a combination of a steroid and a local anaesthetic. The local anaesthetic numbs the nerves, providing short-term and sometimes longer-term pain relief by creating more space around the compressed nerves. On the other hand, steroids provide long-term pain relief by reducing swelling and inflammation around the nerves.

What happens before Sacral Epidural /Caudal Epidural Injection?

Before the procedure, the patient will typically undergo a thorough evaluation by a specialist to determine the underlying cause of their pain and whether a Sacral Epidural /Caudal Epidural Injection is an appropriate treatment option.

This evaluation may include a physical exam, medical history review, and diagnostic tests such as imaging studies (e.g., X-rays, MRI, and CT scans).

If the specialist determines that the procedure is appropriate, the patient will typically receive instructions on preparing for the procedure. This may include:

  • Discontinuing the use of blood-thinning medications, such as warfarin, for a specified period before the procedure
  • Do not stop any medication before talking to us.
  • Arranging for someone to drive them home after the procedure.
  • Inform us of any allergies, medications, or medical conditions you have. If there is an active infection, the procedure is not carried out.

What happens during the procedure?

The Sacral Epidural /Caudal Epidural Injection is an outpatient procedure that is conducted in the hospital under local anaesthesia and sometimes under sedation.

The procedure is performed in a fluoroscopy(X-ray) room. Although the injections only take a short time, the entire procedure may last up to 30 minutes.

During the procedure, the patient will be asked to lie on their front, and the doctor will take measures to ensure their comfort. The doctor will clean the skin of the neck or back area with antiseptic and cover it with sterile drapes. Local anaesthesia will then be injected into the skin to numb the area.

Next, the doctor will use X-ray images to guide the needle to the correct position.  X-ray dye is used to check that the spread of the injection is satisfactory. There may be some discomfort in the back at the time of injection. Finally, a mixture of local anaesthesia and steroid will be slowly injected into the epidural space.

After the procedure, which usually takes around 30 minutes, the patient will be monitored briefly and then typically allowed to go home within half an hour after you have emptied bladder.

During the procedure, your vitals are continuously monitored.

In some cases, administering the injection may not be possible due to anatomical variations or complex structures that pose a risk of harm. If this occurs, alternative treatment options may need to be considered and discussed with the patient later.

What can I expect after the injection?

The injection of local anaesthesia may result in immediate symptom relief.
On the other hand, the steroid medication usually takes two to three days to start taking effect and may peak at one to two weeks. It's important to continue regular pain relief medication as needed.
The success of the injection in reducing pain and its duration may vary from person to person.

What are the potential side effects of the procedure?

The most frequently observed side effect of the injections is mild tenderness and/or bruising at the injection site, which typically resolves within a few days. Individuals may sometimes experience increased pain for a few days following the injection, but this should subside.
Although uncommon, more severe side effects may occur, such as bleeding, infection, Dural puncture, nerve damage, temporary numbness and bladder disturbance, and an allergic reaction to the medications used during the procedure.

Although rare, seeking medical attention promptly is important if you feel unwell.

Learn more about condition:

Back Pain: The underlying factors contributing to back pain.