In brief
- The injection delivers a powerful anti-inflammatory directly to the nerve root that is generating your radiating leg pain.
- Hold NSAIDs and aspirin for 24 hours; blood thinners have longer holds.
- You may feel immediate, temporary relief for several hours, then a flare of soreness for 2 to 5 days as the steroid takes effect.
- Peak relief typically develops 3 to 7 days after the injection.
Understanding your diagnosis
Lumbar radiculopathy, often referred to as sciatica, occurs when a nerve root in your lower back becomes compressed or irritated. This is frequently caused by a disc herniation, degenerative changes, or spinal stenosis. This irritation leads to the sharp pain, tingling, or weakness that you may feel radiating from your lower back down into your hip, leg, or foot.
The treatment
An epidural steroid injection is a targeted, minimally invasive procedure in which a powerful anti-inflammatory medication (steroid) is delivered directly into the epidural space of the lumbar spine. By reducing the swelling and calming down the irritated nerve, this medication helps alleviate your radiating pain and improves your ability to participate in daily activities and physical therapy.
Our approach
We use the transforaminal approach for maximum precision. This method allows Dr. Pugh to deliver medication directly into the neural foramen, the specific opening where the irritated nerve root exits the spine, so the anti-inflammatory steroid is placed precisely where it is needed most.
Before your procedure
For your safety, certain medications must be held before your procedure to minimize the risk of bleeding, following American Society of Regional Anesthesia guidelines. This procedure requires the 24-hour NSAID hold.
| Medication type | Examples | Required hold |
|---|---|---|
| NSAIDs | Ibuprofen, Motrin, Aleve, naproxen, meloxicam | 24 hours |
| Salicylates | Aspirin, all doses | 24 hours |
| Antiplatelets | Plavix (clopidogrel), Brilinta | 7 days |
| Antiplatelets | Effient (prasugrel) | 10 days |
| Anticoagulants | Eliquis, Xarelto, Savaysa, Pradaxa | 5 days |
| Vitamin K antagonist | Coumadin, warfarin | 5 days (INR below 1.5) |
Restarting
Most medications can be restarted 24 hours after the procedure. NSAIDs and aspirin may be resumed immediately.
Fasting, sedation, and your ride home
- If you are receiving sedation, nothing to eat or drink for six hours before your appointment. Essential morning medications may be taken with a small sip of water only.
- We offer light or deep sedation. The level is decided by the physician and anesthesia team based on the procedure and clinical need.
- Any patient receiving sedation must be accompanied by a responsible adult driver to take them home.
Where to go
Procedures are performed at one of three facilities: our clinic at 1925 Hospital Place, ACOM at 6449 Central Park Blvd, or Hendrick South at 6399 Directors Pkwy, Suite 100. Your appointment paperwork tells you which one. Please arrive early for registration and pre-procedure preparation.
Procedure day
- Performed under live X-ray (fluoroscopy) for maximum precision.
- We use local numbing medication to ensure a comfortable experience.
- The entire procedure typically lasts about 15 minutes.
- You will be able to walk out and go home shortly after the injection.
Benefits
- Significant reduction in pain radiating down the leg.
- Reduced need for oral pain medications.
- Improved ability to perform physical therapy.
Recovery
- Return to regular activity the next day.
- Full relief usually develops over 3 to 7 days.
- A brief follow-up will be scheduled to assess your relief and function.
Afterward: what to expect
- The window. You may feel immediate, temporary relief for several hours due to the local anesthetic.
- The flare. Expect a potential temporary increase in localized soreness or a bruised sensation for 2 to 5 days as the steroid takes effect. Use ice packs (20 minutes on, 20 off) for localized soreness.
- Results. Peak clinical relief typically occurs between 3 and 7 days after the injection.
- Blood glucose. Expect a temporary rise in blood glucose levels, which usually resolves within a few days. Diabetic patients should monitor their sugar levels closely for 48 to 72 hours after the procedure.
Activity
Wound care
Your procedure in one paragraph
You have undergone a lumbar transforaminal epidural steroid injection, a specialized procedure designed to treat chronic back and leg pain (sciatica) originating from the lower spine. Unlike a standard epidural, this approach targets the specific nerve root opening (foramen) where the nerve exits the spine. We have delivered a concentrated blend of anti-inflammatory medication and local anesthetic directly to the source of the nerve irritation to reduce swelling and mute pain signals.
Follow-up schedule
- 1
1 month
Formal functional assessment of how well the injection worked.
Call us right away if you notice
- New or worsening leg weakness, numbness, or foot drop
- Sudden loss of bowel or bladder control
- Fever above 101.5°F, chills, or drainage at the site
- A severe headache that worsens when sitting or standing
This guide is the same information as the printed handout from Abilene Pain. It is general information and does not replace the instructions your care team gives you at your visit. Your care team: Nicolas Pugh, MD · Adrianne Anders, NP · Ted Chaka, PA.