Caudal Epidural Injection
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What is a caudal epidural injection?
The proper terminology for this procedure is “Caudal epidural injection with wire-guided catheter (or Myelotec Navicath) using hyaluronidase for decompression of the lumbosacral nerves.” This injection is designed to reduce pain and inflammation in the lumbar spine. We are currently the only clinic in Arizona using hyaluronidase, which is an enzyme that specifically targets epidural scar tissue from previous spine surgery. This injection may reduce pain from a variety of spinal pain problems, including intervertebral disc disease, facet joint arthritis, scar tissue and spinal stenosis.
What medications are used during the procedure?
The injection consists of Lidocaine, Kenalog and Hyaluronidase. Lidocaine is a local anesthetic that can rapidly reduce pain symptoms. Kenalog is one of the most potent anti-inflammatory medications currently available. Hyaluronidase is an enzyme that specifically targets scar tissue in the spine from previous surgery. These medications have a long record of safety and effectiveness.
Why do you use this approach?
After spine surgery, the anatomy of the area may have been changed drastically. An epidural injection performed in the traditional manner may encounter scar tissue and disrupted spinal anatomy. Proper placement of medications may be very difficult. Therefore, a catheter is placed through the sacral hiatus (near the tailbone) and advanced under scar tissue using X-ray guidance (fluoroscopy.)
What can I expect during the procedure?
After checking in at the Surgery Center, you will be interviewed by the admission nurse who will take a full history, then start an IV. You will also be seen by the medical staff of Arizona Pain Specialists prior to the procedure, at which time you will have the opportunity to have any questions answered.
After being placed on the treatment table, intravenous sedation will be administered to make the procedure as comfortable as possible. The injection usually takes only several minutes. Following the procedure, you will be allowed to rest for approximately 30 minutes in the recovery area prior to discharge. You must have a responsible adult take you home.
When will I begin to feel pain relief and how long will it last?
Most epidural injections will provide pain reduction within 48-72 hours. The length of pain reduction depends on multiple factors including the age of the patient, the underlying anatomical problem, occupational activities and adherence to a formal physical therapy program.
The recovery from the procedure is short. You may have minor discomfort at the injection site which usually resolves within 24 hours. If you continue to have symptoms, please refer to Surgery Center discharge instructions. You also may call Arizona Pain Specialists if there are any concerns.
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