When is epidural infiltration indicated?
Epidural block or epidural infiltration is widely known for its use as an analgesic in labor with catheter placement or even for the treatment of sciatica. Moreover, although its use in the cervical spine is not as well known, it is highly effective. Therefore, it is an option to be taken into account when the following pain conditions are present:
- Disc herniation with radiculopathy.
- Canal stenosis.
- Postherpetic neuralgia.
- Complex regional pain syndrome.
It should also be noted that in patients with multilevel symptoms or with a bilateral pain clinic, this technique would be more effective.
What does epidural infiltration consist of?
This is a technique in which the epidural space is identified and then a local anesthetic and corticoids are administered. A Tuohy needle is used to do it with the highest precision. This technique should never be performed blindly, that is why in our center it is always performed under fluoroscopic guidance and with the patient in prone or seated position.
In general, we can access the epidural space through the access point marked by the C7 and T1 vertebrae (in the case of the cervical space) and the place closest to the lesion, in case the lesion is in another area. Then, the Tuohy needle is introduced very slowly, under radioscopic control until we are sure that the needle has been correctly placed.
When the epidural space is reached, a loss of pressure due to the syringe system, also known as a pending drop, can be seen. We then inject a minimal amount of contrast that should draw a radiopaque line in the posterior epidural space and, just at that moment, levobupivacaine, a local anesthetic, and corticosteroids are injected. In the event that intravascular or subarachnoid contrast diffusion is observed, the procedure should be discontinued as a precaution.
What are the possible complications?
The potential complications that could occur are:
- Inadvertent dural puncture
- Spinal injury.
- Epidural hematoma.
- Inadvertent vascular puncture.
- Spinal cord infarction due to particulate steroids.
However, these complications hardly occur when the physician who performs them is an expert in this type of infiltration. It is also essential to perform it under fluoroscopic guidance and following the recommendations mentioned above.
Does it require general or local anesthesia and is it necessary to stay in the hospital?
The procedure is performed under local anesthesia and on an outpatient basis, requiring only a post-procedure follow-up. Occasionally, it is possible that the patient may notice a slight weakness in the extremities for 30-90 minutes, but this does not pose any risk to the patient, but is only the logical consequence of the anesthetic infiltration.