How is this procedure done?
A caudal epidural steroid injection is typically done to treat lower back, rectal or groin pain.  It is performed at the base of the spine just above the tail bone or coccyx.  A small needle is inserted at this location and advanced to the epidural space.  An x-ray (fluoroscopy) machine will be used so that we can be sure of where the needles are placed.  Once we identify the epidural space, we will inject a long-acting steroid and, in some cases, a local anesthetic agent to bathe the structures that are inflamed (disk and nerve roots) which should help to decrease your pain.  Sometimes we will feed a small plastic catheter into the epidural space to allow us to inject near the nerves in the lower lumbar spine to decrease inflammation at that level.

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What should you expect?
We may start an intravenous line so that we can give you intravenous fluids, medication to relax you or allow us to treat nausea or other problems.  You may have some numbness around your buttock area for a few hours.  Rarely, you may have a little muscle weakness in your legs for a few hours.  Once the local anesthetic has worn off, typically after several hours, your pain may return.  After about 24-36 hours, the steroid will begin to start reducing the inflammation, and if the steroid is going to work, it should start doing so after this time period. If your pain gets a lot better, we will repeat the injection, we will typically do another in 2-4 weeks time.  If no substantial effects are obtained after one or two injections, we will need to try other alternatives.

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What are the side effects?
Anything more than a small amount of pain, bleeding or swelling at the site of the injection is unusual.  If you develop any other problems, please call immediately so that we may recommend appropriate actions or go to the nearest emergency room for evaluation.