I had my lumbar epidural yesterday despite a last minute "it's off, it's on" shuffle by the Royal Berkshire Hospital's list administration due to a complicated case coming in the day before. As this treatment is fairly common, as all Mums out there will know, I thought I'd share what happens.
The aim of this treatment is to further suppress the symptoms caused by my broken spine (early onset degenerative spondylolisthesis at L4/L5 with associated spinal stenosis, herniated disc and radiculopathy due to bilateral root compression of my sciatic nerves) and to finally determine if the break is the sole cause of the symptoms I've been experiencing.
This procedure involves placing a needle into the insulating material of the spinal cord itself (the dura) and then injecting a local anaesthetic followed by a long acting steroid to take down the inflammation. You are awake, seated and sedated. The sedation means that one has to starve the night before though you can drink water up to an hour before checking in at the hospital. These restrictions also allow the medical staff to put you completely under and do a caudal epidural there and then instead should they be unable to do the lumbar procedure.
Having signed the consent form, you have a needle in the back of your hand to enable drugs to be administered should you 'take a turn' and so that fluids can be given to you afterward. Frankly, the placement of this needle is worse than the larger cannula they put into your spine!
You then sit on the long side of a treatment couch with your feet placed up on a stool so that your knees fall out to the sides. You are asked to cross your arms at the wrist, to curl forward and to tuck your chin into your chest. The anaesthesiologist cleans your back, applies a self-adhesive pad over most of your back and then feels your spine for the correct location to insert the needle. Placement of the needle is not very painful due to the sedation but does involved a bit of pushing and tweaking. The local anaesthetic is injected and feels cold. A couple of minutes pass whilst this takes effect. A cannula is then fed in over the needle so more pushing! You are then instructed to hold very still as the cannula is fed into the spinal dura itself. The methyl prednisolone (Depomedrone) is then injected. This does not create pain but did produce in me a feeling a bit like all my back muscles going into spasm at once from waist to the bottom of my shoulder blades. The needle, cannula and pad are removed and the wound site dressed. You then lie down on the treatment couch and get taken to the recovery room.
In recovery, you are fitted with a saline drip as good hydration helps the sedation and local to be flushed out of your system. You are instructed to drink plenty of water the following day for the same reason. You are placed in a semi-seated position to ensure that the epidural fluids move toward your feet rather than your chest and head where they could cause problems with your breathing, heart-rate or consciousness. The recovery nurse fits you with an automatic blood pressure cuff which activated every five minutes or so, a finger clamp for measuring your pulse, and gets you to take a deep breath. The nurse also checks if you can move your legs and feet as the local can cause temporary paralysis. After a while, the nurse sprays you from toe to chest with a cold alcohol. Areas that cannot feel the coldness (you may still feel yourself being sprayed) are affected by the epidural. In my case, I had to be sat in a more upright position as the affects of the epidural were occurring too far up toward my chest.
Once the recovery nurse is satisfied you are safe, you are returned to the day surgery ward to wait for the affects of the local to wear off sufficiently to be able to take a pee. You have your drip removed once the nursing staff are assured that you are drinking enough water or weak squash. The best bit is being fed toast!
You need someone to collect you and they are asked to sign a document undertaking to escort you home and to take care of you for an absolute minimum of 24 hours following the epidural. You are not permitted to drive, operate any machinery (not even the toaster) or to do any physical work or sign documents due to the risks of you fainting or worse and of having your judgement impaired by the sedation. Ideally, this part of recovery should extend to 48 hours. You are given emergency contact numbers should you experience any ill affects and told in no uncertain terms that if you are suffering from certain of them, you are to contact the hospital AT ONCE.
I am writing this toward the end of recovery day one. I was wobbly on my feet this morning and felt a bit shaky from shock this afternoon. My lower back is achy from the epidural itself and from loosing some blood when the cannula was removed. The nursing staff are right to emphasise rest, drinking water and allowing yourself to be nursed by your responsible adult as I feel rather tired in the too much physical labour sort of way (think 5-6 hours weeding and tidying the garden including mowing and raking the lawn). I intend to try going to a half hour mass tomorrow at 10am as I feel I could use some fresh air after being baked half silly from the over-heated ward yesterday but I'm certainly not doing much else. I would strongly advise making sure all your housework was out of the way before you have this done, especially having a freshly laundered bed to crawl into!
References :
http://www.spineuniverse.com/treatments/pain-management/lumbar-epidural-injection
http://www.spineuniverse.com/conditions/spondylolisthesis/spondylolisthesis-back-condition-treatment
http://www.spineuniverse.com/conditions/spondylolisthesis/degenerative-spondylolisthesis-lumbar-spine
The aim of this treatment is to further suppress the symptoms caused by my broken spine (early onset degenerative spondylolisthesis at L4/L5 with associated spinal stenosis, herniated disc and radiculopathy due to bilateral root compression of my sciatic nerves) and to finally determine if the break is the sole cause of the symptoms I've been experiencing.
This procedure involves placing a needle into the insulating material of the spinal cord itself (the dura) and then injecting a local anaesthetic followed by a long acting steroid to take down the inflammation. You are awake, seated and sedated. The sedation means that one has to starve the night before though you can drink water up to an hour before checking in at the hospital. These restrictions also allow the medical staff to put you completely under and do a caudal epidural there and then instead should they be unable to do the lumbar procedure.
Having signed the consent form, you have a needle in the back of your hand to enable drugs to be administered should you 'take a turn' and so that fluids can be given to you afterward. Frankly, the placement of this needle is worse than the larger cannula they put into your spine!
You then sit on the long side of a treatment couch with your feet placed up on a stool so that your knees fall out to the sides. You are asked to cross your arms at the wrist, to curl forward and to tuck your chin into your chest. The anaesthesiologist cleans your back, applies a self-adhesive pad over most of your back and then feels your spine for the correct location to insert the needle. Placement of the needle is not very painful due to the sedation but does involved a bit of pushing and tweaking. The local anaesthetic is injected and feels cold. A couple of minutes pass whilst this takes effect. A cannula is then fed in over the needle so more pushing! You are then instructed to hold very still as the cannula is fed into the spinal dura itself. The methyl prednisolone (Depomedrone) is then injected. This does not create pain but did produce in me a feeling a bit like all my back muscles going into spasm at once from waist to the bottom of my shoulder blades. The needle, cannula and pad are removed and the wound site dressed. You then lie down on the treatment couch and get taken to the recovery room.
In recovery, you are fitted with a saline drip as good hydration helps the sedation and local to be flushed out of your system. You are instructed to drink plenty of water the following day for the same reason. You are placed in a semi-seated position to ensure that the epidural fluids move toward your feet rather than your chest and head where they could cause problems with your breathing, heart-rate or consciousness. The recovery nurse fits you with an automatic blood pressure cuff which activated every five minutes or so, a finger clamp for measuring your pulse, and gets you to take a deep breath. The nurse also checks if you can move your legs and feet as the local can cause temporary paralysis. After a while, the nurse sprays you from toe to chest with a cold alcohol. Areas that cannot feel the coldness (you may still feel yourself being sprayed) are affected by the epidural. In my case, I had to be sat in a more upright position as the affects of the epidural were occurring too far up toward my chest.
Once the recovery nurse is satisfied you are safe, you are returned to the day surgery ward to wait for the affects of the local to wear off sufficiently to be able to take a pee. You have your drip removed once the nursing staff are assured that you are drinking enough water or weak squash. The best bit is being fed toast!
You need someone to collect you and they are asked to sign a document undertaking to escort you home and to take care of you for an absolute minimum of 24 hours following the epidural. You are not permitted to drive, operate any machinery (not even the toaster) or to do any physical work or sign documents due to the risks of you fainting or worse and of having your judgement impaired by the sedation. Ideally, this part of recovery should extend to 48 hours. You are given emergency contact numbers should you experience any ill affects and told in no uncertain terms that if you are suffering from certain of them, you are to contact the hospital AT ONCE.
I am writing this toward the end of recovery day one. I was wobbly on my feet this morning and felt a bit shaky from shock this afternoon. My lower back is achy from the epidural itself and from loosing some blood when the cannula was removed. The nursing staff are right to emphasise rest, drinking water and allowing yourself to be nursed by your responsible adult as I feel rather tired in the too much physical labour sort of way (think 5-6 hours weeding and tidying the garden including mowing and raking the lawn). I intend to try going to a half hour mass tomorrow at 10am as I feel I could use some fresh air after being baked half silly from the over-heated ward yesterday but I'm certainly not doing much else. I would strongly advise making sure all your housework was out of the way before you have this done, especially having a freshly laundered bed to crawl into!
References :
http://www.spineuniverse.com/treatments/pain-management/lumbar-epidural-injection
http://www.spineuniverse.com/conditions/spondylolisthesis/spondylolisthesis-back-condition-treatment
http://www.spineuniverse.com/conditions/spondylolisthesis/degenerative-spondylolisthesis-lumbar-spine
