posted by : Dr. Barnetton: 15 October, 2018
Probably the most overused pain management tool in America. Classically performed in a series of three. Usually an Anesthesiologist sees the patient before the Operating Room schedule at the request of another Doctor. The patient is told he will probably get a series of three epidurals at two week intervals. Often the patient has undiagnosed back pain or if he is lucky to have the procedure performed for the correct reason, LEG pain. Local anesthetics are mixed with long acting steroids and blindly placed into the epidural space.
In many patients there is often not a diagnosis but a complaint and some abnormal finding on an X-ray or MRI that rarely match the provocative factor, blind injections don’t enter the epidural space 30% of the time with experienced injectionists, and there is no scientific evidence that a series of three epidurals is effective. This pattern probably originated from the financial allowance by Medicare in 1965 to obtain payment for three epidurals. The two week interval more than likely has been adopted as the commonly used medications physically are in place for about two weeks.
Steroid products for pain and inflammation are all variations on a theme. Quite similar to a patients own adrenal steroid, they can provide systemic results whether they are administered orally, IV, rectally or in the epidural space.
Proper placement under Fluoroscopy by trained Doctors is the U.S. standard of care. They do not cure anything in pain care. They are palliative and provide some pain relief, and if used appropriately should be dominantly used for the reduction of inflammation of a nerve root (left), thus reducing Sciatica symptoms. They are most effective when placed near the root.