Professor Iakiv Fishchenko · Patient information
What happens during an epidural injection
Targeted medication delivery starts with checking that the procedure is indicated. Professor Iakiv Fishchenko's team reviews symptoms alongside MRI findings, agrees the approach and performs the procedure under X-ray guidance.
On this page
What to prepare for your consultation
Send your existing complete MRI study in DICOM format, the radiology report and a brief symptom summary: where the pain is, where it radiates, when it started and how it limits activity. Include previous treatments and explain what helped and for how long.
If you have had spine surgery, include the discharge summary and operation report. Send CT scans and other investigations if available. You do not need to arrange every possible investigation yourself before first contacting us.
Medicines and conditions you need to report
Provide a complete list of regular and recently taken medicines. Be sure to mention anticoagulants and antiplatelet medicines, allergies, diabetes, clotting disorders, pregnancy or possible pregnancy, fever and other signs of infection.
Do not stop or restart medicines that affect blood clotting on your own. The doctors will agree a plan that takes account of both bleeding risk and the risk of interrupting treatment. If you have diabetes, discuss glucose monitoring after the steroid in advance.
What to clarify before the procedure day
Agree the procedure, target level, expected benefit, alternatives and risks. Clarify instructions on food, drinks and medicines: these depend in part on the planned pain relief. The team will determine which tests are needed.
Arrange someone to accompany you and your journey home. Do not drive on the day of an epidural injection. For catheter adhesiolysis, agree the duration of treatment and observation separately.
Approaches to the epidural space
The transforaminal approach delivers medication through the region of the intervertebral foramen near the selected nerve root. The interlaminar approach enters between the vertebral laminae. The caudal approach reaches the epidural space through the lower opening of the sacral canal, the sacral hiatus.
These are different routes of administration, not interchangeable procedures for every patient. The doctor selects the approach based on symptoms, images, previous surgery and risks. Planning cervical procedures requires particular care. Discuss the proposed approach and its features before the procedure.
X-ray guidance and medication delivery
After skin preparation and local anaesthesia, the doctor advances the needle to the planned area under X-ray guidance. When there are no contraindications, contrast is used to check needle position and the spread of medication. Contrast use and necessary precautions are agreed beforehand.
Once the position has been confirmed, an anti-inflammatory steroid is injected, sometimes with a local anaesthetic. The approach and medicines depend on the affected level and individual risks. The term 'block' does not imply an identical technique in the lumbar and cervical spine.
You may feel pressure, brief burning or a sensation travelling along the limb. Tell the doctor immediately about sharp or unusual pain. X-ray guidance improves accuracy but does not make the procedure risk-free.
Observation before going home
After the procedure, the team assesses how you feel, muscle strength and sensation. The duration of the procedure and observation depend on the approach, pain relief and your condition. The doctor decides when you can go home.
Before discharge, obtain advice about medicines, puncture-site care, activity and follow-up. This page describes an epidural injection. For catheter adhesiolysis, our team uses a separate inpatient protocol with three days of medication administration.
Risks and reasons to postpone the procedure
Before the procedure, we discuss possible pain, numbness or weakness, headache, raised glucose, allergy, bleeding and infection. Rare, severe neurological complications cannot be ruled out completely.
If there is active infection, an uncorrected clotting disorder or an allergy to a required medicine, the procedure is not performed until the plan has been reviewed. Tell the team about any new symptoms or changes to medicines before travelling.
Sources: The professor's patient information: epidural injections · FDA: work on rare, serious neurological complications of injections.
Patient questions
Is X-ray guidance needed?
The professor's team performs epidural injections under X-ray guidance, checking needle position and, when there are no contraindications, using contrast to confirm the spread of medication.
Is general anaesthesia needed?
An epidural injection is performed with local anaesthesia. The need for additional pain relief or sedation is agreed individually before the procedure.
Should I stop my medicines before an injection?
Give the doctor a complete list of your medicines. Agree any changes with the doctors, particularly those involving anticoagulants or antiplatelet medicines.
Next step
Let's start with your symptoms and MRI
Send your existing scans and a brief treatment history.
We will explain whether an injection or adhesiolysis may be appropriate, or whether another treatment should be discussed. The preliminary scan review is free.