Caudal Epidural Injection
What is a Caudal Epidural injection?
There is a small opening right at the base of your spine that permits easy access to the epidural space within the spine. This is called the Caudal (sacral) hiatus. Injecting into the epidural space using the Caudal hiatus is very safe, comfortable and effective compared to other types of epidural injection.
What is the purpose of a Caudal epidural?
Pain can be produced from the ligaments, discs and nerve rootlets within the epidural space. Bathing all these structures in a large volume of local anaesthetic and cortisone is capable of producing weeks or months of relief from such pain. Even if the duration of relief is much shorter than this, it can help with making a diagnosis of the source of your back pain.
How is a Caudal Epidural performed?
You lie on the operating theatre table while x-rays are taken to establish where the needle should go. After a sterile preparation, local anaesthetic is used to numb the skin and superficial tissues. The needle is passed through the anaesthetised tissue into Caudal hiatus under x-ray guidance. When the needle looks to be in the right position, adequate placement is confirmed by injecting a little contrast dye. If the dye doesn't spread in a pattern, which confirms that it's in the epidural space, it is repositioned until the right pattern is seen.
Once the needle is confirmed to be in the epidural space, diluted local anaesthetic and high-strength cortisone is put down the needle, to a total volume of 10ml.
We offer light sedation as part of the procedure if you would like it, though it isn't essential to the success of the injection. The sedation means you won't remember the injection but it's a long way short of a full general anaesthetic. You won't be able to drive for 24 hours after having sedation, and you will have to fast for 4 hours before you arrive.
What happens after the injection?
You will be observed in the recovery room for 30-60 minutes and be free to leave the hospital soon after that. You will have to lie on your back with your feet elevated higher than your head for the first half hour of this time. You may notice some temporary numbness at the injection site or down your leg after the injection. This is due to the fact that some of the injected anaesthetic can pool in the sacrum and affect some nerves more than others. If you are having difficulty walking safely, you may need to be observed for longer, or (rarely) overnight so we can be sure you're able to manage when you leave the hospital.
If you have pain at the site of the injection you should use a cold pack and some paracetamol (Panadol, Herron, Panamax) or ibuprofen (Herron Blue, Nurofen) in the recommended doses for a couple of days.
You will be given a Pain Diary to record the pain levels or any other symptoms you notice over the next few days. This should be returned to Pain Matrix once completed as it helps us plan your further care and monitor how well we are doing our procedures.
In the case of numbness, which has not gone away after 24 hours, or any loss of control over bladder or bowel, you should contact Pain Matrix, or attend an Emergency Department and ask that they contact us if it is after hours.
Please make sure you have made a follow-up appointment with your Pain Specialist. You should ring Pain Matrix following your procedure if one has not already been arranged.