Pre operative advice
On the day of your injection it is important to remain Nothing by Mouth (NPO). Do not eat past midnight the night before your surgery. However you may drink small amount of water to take any medications up to two hours before admission.
Please avoid smoking on the day of your surgery.
Please shower or bathe as normal in the morning, and remove any make up or nail polish.
A number of problems in the spine can present as “nerve pain” that is sharp pain radiating along the pathway of a particular nerve (or nerve root – the root being the portion of the nerve which leaves the spine) such as the sciatic nerve. Often this pain can be overcome by an injection designed to partially numb the nerve and to reduce the inflammation in it which is frequently the cause of the pain.
Many patients, alternatively, suffer from a chronic pain due to a more generalised inflammatory process. Spinal injections can significantly ease this type of inflammatory response in the majority of patients.
For example, you may have pain going down your leg. This pain may be caused by a disc which is inflamed, and therefore pressing against the nerve which runs down this part of your leg. So, if the disc bulge is reduced, from having the injection and then with the help of physiotherapy, the leg and back pain may be reduced.
Patients undergoing these types of spinal injection will be offered a sedative to settle them for the procedure. Not all patients will need this, but it is available if required.
These injections are of two types:
Epidural Injections – e.g. transforaminal epidural. These are performed under local anaesthetic using x-ray guidance to ensure both safety and maximum efficacy. They are performed in the outpatient surgery unit. The procedure does not take long (20 – 30 Minutes at most) and is often very effective. It is performed on an out-patient basis and the patient can return home the same day. There is often some flare-up of symptoms for a day or two after the procedure, but the effect becomes most marked by around 5 days. The effect may last for only a short while (a few hours) or may continue for several days or weeks. Many patients will experience lasting benefit.
Local Blocks – e.g. facet joint injection. These are also performed as an outpatient under local anaesthetic. They can be used to diagnose problems, by specifically blocking pain from one site using local anaesthetic to determine precisely which area of the spine is causing the pain. Thereafter they can be used therapeutically to reduce the inflammatory reaction, which is often the major cause of spinal pain.
Injections may need to be repeated after an interval, as the inflammation may come back especially if the underlying cause, such as obesity, has not been treated.
These procedures are performed by Dr Bhatti, using x-ray’s to ensure that the needle is in the correct place, so that the patient experiences as little pain from the procedure as possible. Sedation (drugs given to make you sleepy) or even general anaesthesia can be administered if required. Some patients may choose to have local anaesthesia to just numb the area but stay awake.
Post operative advice
Following your procedure, you will spend a small amount of time in post-anaesthesia recovery, before being transferred back to your room.
You may spend approximately 3 hours in the hospital before discharge, you will have something to eat and drink here. Following a sedation or light anaesthetic, you should not drive. You may go home on public transport, but it is advised that somebody take you home and stay at home with you for the first 24 hours. Please ensure that you drink plenty of fluids and eat a light diet.
It is also advised that you don’t do the following:
- Drive or Operate machinery.
- Drink any alcohol.
- Make any important decisions, the sedation may stay in your system for around 24 hours and may cloud your logic and co-ordination.
- Take sleeping tablets, or any medications that make you sleep (Benadryl for example.)
It may take a few days for the medications in the injections to take effect. Please call the office if you have any questions.
From 1 week post injection, you will start physical therapy. These exercises are very gentle initially and increase over 6 weeks, so that by 12 weeks post-op you will be in the gym, swimming or cycling regularly.
Patients are seen at 6 weeks post-injection and then at 3, 6 and 12 months with x-rays taken at each visit to determine the stage of healing. If metal screws are used these may be removed 1 – 2 years later, but this is usually not required.