View Full Version : epidural steroid injection

20th February 2006, 11:24 AM
As some of you may know, I was written up for a caudal ESI (caudal meaning it's injected between the tailbone and sacrum, rather than into the lumbar region), to treat the neurological symptoms I've been having as a result of narrowing of the spinal canal and nerve root exits at L4-5 level.

Because as far as I knew this was a standard procedure, and 150 miles therefore seemed a long way to go for it, I arranged to have it done locally. Alarm bells started to ring when I went to my GP to arrange it and was told that at Great Western it is done by the surgeons, not anaesthetists, but I wasn't too worried even so. However, when the appointment came through, there was not only an appointment for the procedure but also for a "pre-op".

I had the pre-op on Friday and discovered that they really do mean pre-op - for whatever reason, at GW, not only is it done by surgeons, it is done under general anaesthetic. Considering that epidurals are often used to *prevent* the need for a general anaesthetic, this seems madness to say the least. So they weighed me and took my blood pressure and checked the amount of neck extension that I have. Surprisingly, nothing was said about my weight, but they flapped terribly about my blood pressure, and told me that unless I get it checked again before Friday there's no way the anaesthetist will proceed with it - it read as 140/96, which is pretty much where it has been for the last 7 years or so. Apparently this is high enough to make a general anaesthetic extremely risky, but bizarrely if I get it tested twice between now and Friday (the date set for the op) and it reads much the same, apparently they will do it. This makes no sense to me as I would expect that if it is routinely that high it should be a worse worry than if it was an anomaly??

Then there's the neck extension - I tipped my head back as far as it goes, forcing it a little, so that I actually had pins and needles in my arms, and the nurse starts frowning and tutting, and looking worried and asked me if that was as far as it went, and scribbled on my notes when I confirmed this. I happen to know that the reason for this test is that unless an anaesthetist is particularly skilled, it can be quite dangerous for them to intubate someone with a stiff neck. So as I'm sure you can imagine, by this point I was really starting to worry. And that's quite apart from the fact I just don't want a general anyway because I feel like hell after them even when it's just a short one (actually, I think it's worse after a short one for something small - at least after spine surgery, you feel rough because of that, so you don't really notice the additional effect of the anaesthetic much!)

I've spent the weekend in a flap, really worried about this with my rational side saying that realistically nothing will go wrong, but all other parts of me saying I don't want to be someone's pincushion practice and in the hands of an anaesthetist who probably doesn't have the faintest idea how to deal with the complexity of my situation. It didn't help my level of calm that 2c was not impressed with it all either - he's normally a good barometer of whether I'm being unreasonable or not.

So. This morning I rang QMC and spoke to Mr Webb's secretary, who was very kind and understanding (thankfully - I tried to be calm and rational, but was so worried I'd sound like a crank that I probably did just because of that!), and is pretty sure that they do indeed do it by anaesthetist, without a general at QMC. She sees no reason for me not to re-arrange to have it done there, so when the spinal fellow is back from leave next week will arrange it for me. The office seemed mystified by the idea of it being done under a general, which confirms my worries, and she seemed to agree with my fear of them being concerned by my neck extension, which would not be a problem for a specialist anaesthetist at QMC even if they should find they cannot do it without a general in my case.

I am *so* relieved by this. I really just did not feel confident at all with GW. I'm curious though, have any of you ever heard of epidurals for back pain being done under general anaesthetic?

20th February 2006, 11:46 AM
Ok, I asked five people who I work with here, who have had epidurals for back pain.All were done under local anaesthetic and seemed baffled as to why you'd need a general for it.
Incidentally only one out of the five said it did any good!!!!

20th February 2006, 12:22 PM
some bits and pieces

you clearly did the right thing by listening to your alarmbells, all seems very weird, i have never heard of surgeons doing epidurals, for surgical purposes, they woulkd ask anaesthetists to come their epidurals for them, they are the ones who are trained for this

where is this great western hospital? (maybe not so great after all)

bp of 140/96, considering you were all worked up and anxiuos doesn't sound too bad

20th February 2006, 12:46 PM
Sounds like you did the right thing. It doesn't make any sense at all for an epidural to be done under a GA - unless the person doing it didn't feel confident and would prefer not to have the patient asking "are we there yet". :P

Amazed Jean
20th February 2006, 12:51 PM
I would kill for your blood pressure readings - I also would kill if they told me I needed general anesthesia to get an epidural. What they were thinking boggles the mind. Good old gut feeling was right on for you. Have a better day!

20th February 2006, 02:04 PM
No my brother had to have one when he needed an epidural he got nothing except a lot of puncture wounds as the Dr trying to administor it took 3 goes to get it in. The misses needed one when she gave birth to our Erin but i can't remember if the anaesthetist did or didn't

20th February 2006, 07:08 PM
Well, well, well - look what I found, a paper by the Royal College of Anaesthetists and the British Pain Society:
http://www.keele.ac.uk/depts/li/hl/links/a...sindex.htm#gsgp (http://www.keele.ac.uk/depts/li/hl/links/anaestheticsindex.htm#gsgp)

Scroll down to "Recommendations on the use of epidural injections for the treatement of back pain and leg pain of spinal origin (2002)", and have a read. Specifically, under Recommendations, it says:
8. Epidural injections for the treatment of back pain and leg pain of spinal origin should not be performed without good reason on a patient whose conscious level is depressed (as a result of anaesthesia or sedation), or a patient who cannot communicate (as a result of mental health problems or language difficulties).

:nut: :rant: :nut:

(edited to add that that emphasis is *theirs*, not mine)

20th February 2006, 07:25 PM
Titch, It may be an idea to mention this to someone in authority. There must be a reason for why they do it that way, it should be invistigated. Im sure you've thought that already though.

21st February 2006, 09:27 AM
I'm trying to investigate it more thoroughly currently, and while I'm not sure if I'll get a reply, I have contacted the Royal College of Anaesthetists to question this way of doing it (no names involved of course, at this stage, just an explanation and query). The cynic in me suggests that the reason that they are doing it by surgeon is precisely to sidestep the guidelines, but I am aware that that thought is probably cynical, paranoid and unreasonable.....

21st February 2006, 12:58 PM
*insert expletive here* i have never EVER heard of an epidural being given under GA. before i started working around research for spinal surgery, i'd only heard of epidurals used in the context of childbirth and i know that most women who have epidurals it's because they're conscious for the birth!

sounds outrageous, good on you for sorting it out. i've also only ever heard of anaesthetists doing it, like gerbo said, they're the trained ones. it's like having a chest drain taken out - nurses do that because they do it all the time unlike surgeons.

madness. hope you get an appointment at QMC quickly

22nd February 2006, 12:47 AM
I jump straight to the cynical approach i'm afraid titch, comes with the job though ;) Glad you're investigating. My great auntie had an epidural for her hip replacement. pleasent!

24th February 2006, 09:40 AM

Not sure if this is relevant, however, I had an epidural for child birth, and was shocked they want to give it under GA. The epidural means you loose all feeling, sometimes down to your legs, and definitely you lose all bladder and bowel control.

Also, I was told by the anaesthetist that you had to be awake with a local, as it is only you that can tell them if it begins to hurt ie. if it starts to hurt they are heading in the wrong direction!!. This happened with me, i told them and they realigned it quickly.

Hope this helps.