Pain Management with Epidural / Nerve Block

Pain management is required when pain begins to interfere with a person's daily life and overall well-being. Whether it is caused by surgery, injury, chronic condition, or nerve-related disorders, it makes it challenging to live a daily life comfortably. No one should have to live with persistent pain when there are options to treat the condition.

At Gleneagles Hospitals, a team of doctors attends to the patient, understands the cause of the pain, and decides which nerve block should be given. Epidural injections and nerve blocks are advanced pain management techniques that target pain at its source. This helps patients relieve pain and improve mobility, and reduces dependence on pain medications.

Gleneagles Hospitals helps every patient move forward with greater comfort, confidence, and hope for a better quality of life.

Note: An epidural is a kind of nerve block, but not all nerve blocks are epidurals.

An epidural is an injection given into the space around the spinal nerves and used for pain management. The space is called the epidural space. Epidurals can be used to manage various issues, such as -

• Labor pain relief
• Pain relief after surgery
• Chronic pain management
• Before surgery (it is used as an anaesthetic)

There are two types of epidural healthcare providers use -

• Epidural Anaesthesia: Anaesthesia helps block pain and is administered into the epidural space.
• Epidural Steroid Injections (ESI): ESIs help manage chronic pain and inflammation. The anti-inflammatory effects of an epidural steroid injection may last for weeks to months, depending on the condition being treated.

Nerve blocks are used for pain management and treatment in specific organs or particular body regions. The injection of this nerve-numbing substance is called a nerve block.

Different types of pain require different nerve blocks. Here are some nerve blocks used -

• Trigeminal nerve blocks (face)
• Maxillary nerve blocks (upper jaw)
• Supraorbital nerve block (forehead)
• Ophthalmic nerve block (eyelids and scalp)
• Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)
• Cervical plexus block and cervical paravertebral block (shoulder and upper neck)

There are many other nerve blocks, which can be used on the abdomen, pelvis, shoulder, arm, hand, elbow, and other parts of the body.

An epidural injection is used to treat nerve compression and inflammation. These conditions can be caused by certain conditions, such as spinal stenosis, degenerative disc disease, or a pinched nerve.

Whereas nerve blocks are used for isolated pain, migraines, complex regional pain syndrome, or pain from specific nerve roots.

Evaluation of Patients

Before recommending an epidural or nerve block, the pain management specialist conducts a comprehensive evaluation to precisely determine whether the procedure is appropriate and safe for the patient's condition. The goal is to efficiently identify the underlying cause of the pain, assess overall health, and develop a personalised course of treatment to achieve the best possible outcomes.

The evaluation mostly includes:

• Medical history review (including illnesses, surgeries, chronic medical conditions, any history of spine or nerve disorders)
• Pain assessment (pattern of the pain, duration, intensity, location, along with factors)
• Safety assessment (screening for infections, bleeding disorders, pregnancy)
• Physical examination (muscle strength, reflexes, sensation, mobility)
• Diagnostic imaging (MRI scans, CT scans, X-rays, or ultrasound)
• Medical review (blood thinners, pain medication)

People with bleeding disorders, low platelets, or active infections at the injection site are not eligible for an epidural or nerve block. Also, if a person takes prescription blood thinners or has a severe spinal abnormality, they are not suitable for an epidural or nerve block for pain management.

An epidural injection is usually done in the labour room. Injecting the medication is not at all painful; the discomfort may kick in when the skin starts to numb. Getting an epidural stops the pain from travelling from the spine to the brain.

Before the Procedure

• Healthcare providers check the vitals, start an IV, and perform routine blood tests.
• The patient's lower back is cleaned with a cold antiseptic solution to prevent infection.
• Local anaesthesia is injected, which may sting or burn.

During the Procedure

The doctor will guide a special epidural needle through the numbed skin and into the epidural space. A thin, flexible tube catheter is then inserted through the needle.

• Once the catheter is secured in the correct position, doctors carefully remove the needle.
• However, the doctor leaves only the soft tube taped to the back.
• Once placement is confirmed, the pain-relieving medication is administered.

Note: Doctors may test a small dose before injecting the epidural to make sure that the medication is placed in the right area.

Immediate After

• The medication usually takes 10-20 minutes to kick in.
• A heavy numbing sensation starts spreading through the lower abdomen, legs, and toes.
• The catheter stays in place, delivering the medication continuously through a manual or automatic pump as long as the patient needs it.

During delivery, the patient may still feel pressure, but the pain from contractions will diminish. This helps them understand when to push.

The procedure for nerve block injection remains the same. However, doctors use medical imaging tools, such as ultrasound or fluoroscopy, to guide the needle to the nerve (in the case of a nerve block). They might also use a nerve stimulator to deliver a tiny electrical pulse that causes the muscle to twitch. This confirms the exact placement.

Patients can expect pain relief within 10-15 minutes as the local anaesthesia wears off. However, steroid effects can take 2-7 days to develop. Patients can experience:

• Soreness and warmth at the injection site
• Original pain might briefly worsen before improving

After the injection, patients are observed for 15-30 minutes to ensure there are no side effects. The affected area can remain numb for a few hours. Hence, it is advised to protect the area until full sensation returns.

Here are some don'ts after receiving an epidural or nerve block:

• Avoid high-impact movements.
• Do not engage in hazardous activities.
• Do not drive for at least 24 hours or operate power tools
• The most important thing is to stay hydrated and avoid spicy food to prevent nausea.

Though it is rare, certain side effects of an epidural may include: 

• Chronic, long-term pain from the spinal cord or nerve root damage
• Permanent neurological complications from the spinal cord nerve root damage
• Permanent paralysis may be caused by a hematoma, a rare condition where the blood collects around your spinal cord

Epidural injections and nerve blocks are used to relieve pain by interfering with pain signals before they reach the brain. Depending on the conditions they are used to treat, an epidural and nerve block can provide temporary or long-lasting pain relief.

After a thorough evaluation, doctors will recommend the most suitable options that best address the patient's specific condition and the severity of the pain. They may be used to:

• Manage pain during and after surgery
• Relieve chronic pain caused by a condition that may affect the spine, joints, muscles, or nerves
• Treat nerve-related conditions, such as sciatica, herniated discs, spinal stenosis, or nerve compression
• Ease pain during labour and childbirth, while allowing the mother to stay awake and know when to push
• Reduce inflammation and irritated nerves that are caused by swollen or compressed nerves
• Support the diagnosis of pain sources, guiding further decisions for treatment

Choosing Gleneagles Hospitals means choosing a reliable healthcare partner for long-term care. The healthcare team uses:

• Image-guided interventions
• Advanced equipment, such as endoscopic tools and radiofrequency techniques, to block pain signals effectively and safely.
• Treatments are planned by pain management doctors, including anaesthesiologists, neurologists, and physiotherapists.
• These procedures are minimally invasive, resulting in less tissue damage.
• The patients receive round-the-clock care and support.

Persistent pain can affect every aspect of a person's life. Advanced pain management techniques such as epidural injections and nerve blocks are considered effective. These medications block the pain signals at their source and reduce discomfort during childbirth or certain surgeries. However, administering these requires proper evaluation and diagnosis by the expert doctors and surgeons at Gleneagles Hospitals.