Epidural Steroid Injection

This information will help you get ready for your epidural steroid injection (shot) at Memorial Sloan Kettering (MSK).

About Epidural Steroid Injections

Your vertebrae (the individual bones in your back) are separated by rubbery cushions called discs. If a disc bulges (moves out of place), it can irritate your spinal nerves. This causes back and nerve pain. A steroid injection can help decrease nerve swelling. This may help reduce your pain.

Your epidural space goes from the base of your head to the part of your spine that’s below your hips (see Figure 1). A steroid may be injected into any area of your epidural space. Your pain doctor will decide the best location for your injection based on where your pain is.

1 Week Before Your Procedure

Ask about your medications

You may need to stop taking some medications before your procedure. We have included some common examples below.

• If you take medication to thin your blood, ask the doctor who prescribes it for you when to stop taking it and when you can start taking it again. Some examples include:
  • Heparin
  • Rivaroxaban (Xarelto^®)
  • Apixaban (Eliquis^®)
  • Warfarin (Jantoven^® or Coumadin^®)
  • Dalteparin (Fragmin^®)
  • Tinzaparin (Innohep^®)
  • Enoxaparin (Lovenox^®)
  • Clopidogrel (Plavix^®)
  • Cilostazol (Pletal^®)
• Steroids may temporarily increase your blood sugar levels. If you take insulin or other medications for diabetes, you may need to change the dose. Ask the doctor who prescribes your diabetes medications what you should do the morning of your procedure.
• If you’re taking antibiotics, tell the doctor giving your steroid injection. Your procedure may need to be rescheduled.

Arrange for someone to take you home

You must have a responsible care partner take you home after your procedure. A responsible care partner is someone who can help you get home safely. They should be able to contact your care team if they have any concerns. Make sure to plan this before the day of your procedure.

If you don’t have a responsible care partner to take you home, call one of the agencies below. They’ll send someone to go home with you. There’s a charge for this service, and you’ll need to provide transportation. It’s OK to use a taxi or car service, but you still need a responsible care partner with you.

1 Day Before Your Procedure

If you have a fever of 100.5° F (38° C) or higher, call the doctor who scheduled your steroid injection.

The Day of Your Procedure

Things to remember

• Wear something comfortable and loose-fitting.
• If you’re between the ages of 11 and 50 and able to get pregnant, your doctor will ask you to take a urine (pee) pregnancy test before your procedure. This is because you’ll be exposed to radiation from the fluoroscopy (type of x-ray) machine.

What to bring with you

• A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
• Any pain medications you’re taking.

Where to park

MSK’s parking garage is on East 66^th Street between York and 1^st avenues. If you have questions about prices, call 212-639-2338.

To get to the garage, turn onto East 66^th Street from York Avenue. The garage is about a quarter of a block in from York Avenue. It’s on the right (north) side of the street. There’s a tunnel you can walk through that connects the garage to the hospital.

There are other parking garages on:

• East 69^th Street between 1^st and 2^nd avenues.
• East 67^th Street between York and 1^st avenues.
• East 65^th Street between 1^st and 2^nd avenues.

Where to go

Your procedure will take place at MSK’s main building. The best entrance to use is the entrance located at 425 East 67^th Street, between York and First avenues.

At the hospital, take the A elevator to the 3^rd floor. Your procedure will take place in room A341.

What to expect

Once you arrive at the hospital, you’ll be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day. You may be asked to change into a hospital gown and remove any necklaces, chains, and earrings you’re wearing. A pain doctor will review the procedure with you and answer your questions.

When it’s time for your procedure, you’ll be helped onto the procedure table. You’ll lie on your stomach with a pillow under you. Using fluoroscopy (a type of x-ray), your doctor will find the right place to give you your injection.

When the right location is found, you’ll get an injection of local anesthetic (medication to make an area of your body numb). You may feel a small pinprick and then a burning sensation. The doctor will then place the epidural in the area where the local anesthetic was injected. Once they’re sure that the needle is correctly placed, they will inject the steroid. Your doctor will remove the needle and place a bandage over the injection site.

This procedure takes 15 to 30 minutes.

After Your Procedure

At home

For the first 24 hours (1 day) after your procedure:

• Don’t drink alcoholic beverages.
• Don’t drive or do any other task where you need to be alert.
• Don’t remove the bandage from your injection site. You can remove it 24 hours after your procedure. You can shower when you remove your bandage.
• Take your pain medication as prescribed.

You may have temporary relief of your pain for a few hours after your injection until the local anesthetic wears off. Your pain may increase for up to 24 hours after your injection. It’s normal to feel pain again for up to 5 days while the steroids start to work. Talk with your pain doctor about taking an extra dose of your pain medication to help relieve your symptoms. If you have severe pain or if feel pain for longer than 48 hours (2 days), call your pain doctor.

Side effects

Some people have side effects after getting an epidural steroid injection. The most common side effects are:

• Headaches
• Temporary weakness, numbness, or tingling in your arms and legs
• Some soreness at your injection site
• A feeling of fullness or pressure in your back
• Restlessness or sleeplessness

When to Call Your Healthcare Provider

Call your healthcare provider if you have:

• A fever of 100.5° F (38.5° C) or higher
• Pain that gets worse after 48 hours or changes locations
• New symptoms such as shooting pain, burning, or tightness in your back or legs
• Leakage, redness, or swelling at your injection site
• New loss of control of your bowel or bladder
• Any unexplained or unexpected problems