Video of an epidural

Epidural Steroid Injection Video | Epidural Injection Procedure Video

Epidural injections contain a strong anti-inflammatory agent called corticosteroid and an anesthetic for pain relief. It is not the same as an epidural anesthesia given before birth to decrease labor pain. Epidural injections are given to relieve pain in the neck, back, arm and leg due to inflammation of spinal nerves from conditions such as spinal stenosis, spondylolysis, herniated disc, degenerative disc and sciatica.

Epidural injections are administered into the spine. The epidural space is the space between the outermost covering of the spinal cord (dura mater) and the wall of the spinal canal. It is approximately 5mm wide and is filled with spinal nerve roots, fat and small blood vessels.

Indications.

Epidural injections are recommended based on pain patterns and used to treat pain primarily from the spine.

Procedure.

You will be taken to the pre op area where trained nursing staff will get you ready for the procedure, by taking vitals and reviewing your medications. Your blood sugar and coagulation status may also be checked if needed. Then you will enter the procedure room where you will lay, usually, face down on a table.

The injection site is then cleaned and injection of a local numbing agent is given in the area so that you don’t feel pain during the procedure.

A thin hollow needle is then inserted into the epidural space. The doctor is guided by fluoroscopic X-ray to place the needle in the correct position. This system gives real time X-ray images of the position of the needle in the spine on a monitor for the surgeon to view.

A contrast material is then injected through the properly placed hollow needle to confirm that the drug flows to the affected nerve when injected.

When the doctor is satisfied with the position of the needle, the anaesthetic drug and corticosteroid are injected through the same needle inserted in the spine.

You may feel some pressure during the injection but mostly the procedure is not painful. The needle is removed and the injection site is covered with a dry, sterile bandage. The procedure takes about 3-5 minutes to complete.

Risks and Complications

With the use of live imaging though X-ray machines, contrast dye, and physicians trained in the latest interventional techniques, complications are rare. But with all medical procedures, complications may occur. To help minimize risk please follow all directions given to you by your care provider. Have all your treatment options explained, so you are aware of the risks and benefits of these procedures.

Some complications may include:

Spinal Headache: If spinal fluid leaks out of the intrathecal space, you may have a headache that gets better when you lay down. This headache usually gets better by laying flat in bed for 12 to 24 hours and drinking caffeine. However on occasion, headaches may last longer and need further evaluation.

Infection: Your pain physicians clean and sterilize your back before every procedure to prevent this from occurring. On rare occasions oral antibiotics may be needed.

Allergic Reaction: This may occur if you have allergies to any medication used. Typically this is pre treated and on occasion your physician may recommend medications for you to take after the procedure. Pay close attention to any rashes and difficulty breathing because that may indicate need for emergent attention.

Worsening pain:

This may occur after the procedure due to the needle puncture and can last from 3 days to a week. Usually this pain resolves and does not cause any lasting impact.

There are many side effects of corticosteroids. However, by limiting the cumulative dose of medication used, these risks are reduced. However, some symptoms you may feel include:

Insomnia

Heart Palpitations

mood changes

Epidural injections may take 2-7 days to show any effect. They may need to be repeated. And as always, follow the instructions of your care provider and have your questions answered prior to the procedure

YouTube as a Source of Information on Epidural Steroid Injection

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. 2021 May 21;14:1353-1357.

doi: 10.2147/JPR.S307506. eCollection 2021.

Min Cheol Chang¹, Donghwi Park²

Affiliations

¹ Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
² Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.

PMID: 34045894
PMCID: PMC8149278
DOI: 10. 2147/JPR.S307506

Free PMC article

Min Cheol Chang et al. J Pain Res. 2021.

Free PMC article

. 2021 May 21;14:1353-1357.

doi: 10.2147/JPR.S307506. eCollection 2021.

Authors

Min Cheol Chang¹, Donghwi Park²

Affiliations

¹ Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
² Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.

PMID: 34045894
PMCID: PMC8149278
DOI: 10.2147/JPR.S307506

Abstract

Objective: With the advance of the internet, social media platforms have become a major source of medical information. We assessed the reliability, quality, and usefulness of the most-viewed YouTube videos of epidural steroid injection (ESI).

Methods: A search was conducted on YouTube on February 13, 2020, using the keywords "epidural injection," "epidural steroid injection," "epidural transforaminal injection," and "epidural transforaminal steroid injection. " The top 50 most-viewed videos were assessed with a modified DISCERN scale (mDISCERN) and a Global Quality Scale (GQS). Further, the usefulness of information in each video was evaluated.

Results: Only 22% of videos contained information with high reliability, and these were produced by hospitals or physicians. None of the videos provided by media organizations and patients were reliable. As for information quality, only 34% were moderate to excellent quality. Even of the videos produced by hospitals or physicians, approximately half were of generally poor or poor quality. Regarding the usefulness of information, although 76% were assessed to contain useful information, 8% had misleading information. Particularly, four of these videos contained misleading information, and three were provided by patients who experienced ESI.

Conclusion: YouTube is a platform where medical information is actively shared and widespread. Here, we found that the reliability and quality of videos were low even when these were produced by hospitals or physicians. Further, the quality tended to be much lower when it was provided by media organizations or patients. Future efforts by physicians and professional societies to improve the reliability and quality of medical content are necessary.

Keywords: back pain; epidural steroid injection; online media; quality; sciatica; social media.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Cited by

Usefulness of YouTube in Sharing Information about New Gene Therapy for Spinal Muscular Atrophy: A Content Analysis.
Kim KY, Jang CW, Chung SY, Kim M, Cho SR, Cho HE. Kim KY, et al. Healthcare (Basel). 2023 Jan 3;11(1):147. doi: 10.3390/healthcare11010147. Healthcare (Basel). 2023. PMID: 36611608 Free PMC article.
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Jang CW, Bang M, Park JH, Cho HE. Jang CW, et al. Int J Environ Res Public Health. 2022 Nov 17;19(22):15177. doi: 10.3390/ijerph292215177. Int J Environ Res Public Health. 2022. PMID: 36429895 Free PMC article.
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Kim SB, Cho SB, Choi H, Lim S. Kim SB, et al. Anesth Pain Med (Seoul). 2022 Oct;17(4):429-433. doi: 10.17085/apm.22134. Epub 2022 Aug 1. Anesth Pain Med (Seoul). 2022. PMID: 36317436 Free PMC article.
The Quality, Reliability, and Accuracy of Videos Regarding Exercises and Management for Dysphagia in Pediatric Populations Uploaded on YouTube.
Chang MC, Lee BJ, Park D. Chang MC, et al. Children (Basel). 2022 Oct 4;9(10):1514. doi: 10.3390/children9101514. Children (Basel). 2022. PMID: 36291450 Free PMC article.
Assessment of information on YouTube on the effect of acupuncture in patients with COVID-19: A cross-sectional study.
Chang MC, Choo YJ. Chang MC, et al. Medicine (Baltimore). 2022 Sep 16;101(37):e30473. doi: 10.1097/MD.0000000000030473. Medicine (Baltimore). 2022. PMID: 36123912 Free PMC article.

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References

1. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 2007;334(7607):1313–1317. doi:10.1136/bmj.39223.428495.BE - DOI - PMC - PubMed
1. Will BE, Synofzik M. Assessing quality of life in patients with lumbar sciatica. Virtual Mentor. 2005;7(2). doi:10.1001/virtualmentor.2005.7.2.cprl1-0502 - DOI - PubMed
1. Chang MC. Conservative treatments frequently used for chronic pain patients in clinical practice: a literature review. Cureus. 2020;12(8):e9934. - PMC - PubMed
1. Choo YJ, Chang MC. Effectiveness of orthoses for treatment in patients with spinal pain. Yeungnam Univ J Med. 2020;37(2):84–89. doi:10.12701/yujm.2020.00150 - DOI - PMC - PubMed
1. Yang S, Boudier-Revéret M, Chang MC. Use of pulsed radiofrequency for the treatment of discogenic back pain: a narrative review. Pain Pract. 2020. doi:10.1111/papr.12978. - DOI - PubMed

Grant support

This study was supported by National Research Foundation of Korea Grant funded by the Korean government (Grant no. NRF-2021R1A2C1013073).

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media about INVITRO.

Olesya Butuzova

Any pregnant woman is waiting for childbirth - the long-awaited moment of meeting her baby. However, many also experience a contradictory feeling - fear. As a rule, most women who have heard enough stories of "experienced" girlfriends are afraid of pain. That is why a modern pregnant woman thinks not only about the name for the future crumbs, but also about ... pain relief. The most common and, perhaps, the favorite method of pain relief during childbirth is currently epidural anesthesia.

The essence of this method of pain relief is the injection of a local anesthetic under the dura mater of the spinal cord, where the roots of the spinal nerves pass. By "stunning" them, you can save the pregnant woman from pain.

Why is epidural anesthesia good?

Epidural anesthesia is not in vain so popular among both obstetrician-gynecologists and women in labor. It eliminates the pain and gives the woman the opportunity to rest. With a small injection of the drug, the woman in labor can move independently without experiencing discomfort. During the caesarean section, the mother is conscious and does not miss the wonderful moment of the first meeting with the baby.

As a rule, the administration of the drug is carried out in doses, it arrives directly for its intended purpose - to the nerve roots, therefore, the dosages are minimal. All this allows the liver to quickly cleanse the blood and dispose of the remnants without missing the medicine to the baby. Thus, epidural anesthesia is practically safe for the baby.

Pain relief only?

Initially, the purpose of epidural anesthesia was not to facilitate the process of childbirth for mothers, but to stop certain threatening conditions.

Thus, epidural anesthesia has a number of beneficial effects:
Eases the pain of childbirth and gives the woman the opportunity to rest and gain strength for the important period of attempts.
Reduces high blood pressure, hyperventilation of the lungs and adrenaline levels, which has a calming effect on the body. Epidural anesthesia facilitates the opening of the cervix and reduces trauma during preterm labor, coordinates contractions and the work of the muscles of the uterus.
Well, and, most importantly, such pain relief is much safer than the use of intravenous drugs.

How is the procedure performed?

In order to puncture, the doctor must first position the pregnant woman correctly (which can be difficult with painful contractions). It is recommended that the woman in labor sit on a chair, facing the back or lie on her side, curled up.

The puncture site is carefully cleaned with antiseptic solutions to minimize the risk of infection.

The skin and subcutaneous tissue are punctured with a local anesthetic to numb the insertion of a needle under the dura mater of the spinal cord.

With a special needle, the doctor enters the epidural space and passes a catheter through it, through which the drug is delivered.

Medical indications for epidural anesthesia:

Caesarean section.
Diseases of the heart, including defects, - the load on the heart decreases.
Diseases of the kidneys.
Diabetes mellitus.
High blood pressure. Epidural anesthesia helps to reduce it.
Preterm pregnancy. Epidural anesthesia helps to relax the muscles of the pelvic floor and reduce the resistance exerted by the baby's head. The baby comes out smoothly and gently.
Discoordination of labor - a condition in which contractions become irregular, frequent, painful and unproductive. They exhaust a woman, but do not contribute to the birth of a child. Epidural anesthesia puts in order the tone of the uterus and muscle contractions, thereby coordinating labor activity.

But epidurals are not for everyone. There is a whole list of contraindications to such anesthesia.

Our expert

Alla Misyutina, doctor of the INVITRO Medical Offices Department

. However, epidural anesthesia is one of the preferred methods of anesthesia in obstetrics. The onset of action of this pain relief is gradual and slow. Pain relief usually develops 10-20 minutes after epidural administration and may be continued until the end of labor as additional doses of drugs can be administered through the epidural catheter. After childbirth, the catheter is removed and after a few hours all sensations return to normal. Anesthesia involves a complete blockage of sensations and movements, it is used more often during a caesarean section.

Epidural analgesia is sometimes performed during childbirth, with the help of which only painful sensations are removed. Then the nerves responsible for motor functions remain partially in working order, and if desired, the woman can move - roll over, sit down, stand. Contractions become painless and are felt by the woman in labor only as pressure below, on the rectum. With a competent approach of doctors - gynecologists and anesthesiologists - the risk is minimal. Obstetrician-gynecologists widely promote this type of pain relief, and many women easily agree to its use.

About side effects

But, like any other useful medical manipulation, epidural anesthesia is not without side effects.

The most common is lowering blood pressure. This is fraught with impaired placental blood flow and hypoxia, that is, oxygen starvation in the baby.

The second serious reaction may be allergic. To prevent anaphylactic shock at the beginning of the procedure, a trial administration of the drug is carried out. If the woman in labor felt pain, burning or itching in the puncture area, then the doctors “cover up” the anesthesia with antiallergic drugs.

When pierced, the drug may enter the spinal canal, which is fraught with difficulty breathing and a drop in blood pressure. It is also possible to injure the roots of the spinal nerves and pain in the limbs. When the drug is injected under the dura mater of the spinal cord, there is a risk of getting into the epidural veins. In such cases, severe complications develop - a sharp drop in blood pressure, heart rhythm disturbance and dizziness. Often this situation is accompanied by numbness of the tongue.

Bacteria entering the puncture site can lead to meningitis.

If the dura mater is damaged and, as a result, cerebrospinal fluid enters the epidural space, headache may occur. It appears a few days after childbirth and can last up to a month and a half.

With regard to side effects on the part of the child, this may be respiratory depression, dysmotility, difficulty sucking.

However, I would like to note that according to statistics, all these complications are rare.

Thus, epidural anesthesia is an effective way of pain relief during childbirth, helping the mother to gain strength before meeting the baby.