A caudal epidural is a spinal injection that is used for pain in the leg (often on the sole or outside of the foot) due to the compression or inflammation of a nerve in the lower part of the back. It can sometimes be helpful for pain coming from one of the lowest disks in the spine. A caudal is performed under local anaesthesia, and using xrays to identify the correct position and ensure that the injected medication reaches the right spot. In common with many injections, a combination of local anaesthetic and a steroid* are used. The steroid is a strong anti-inflammatory medication, and it can reduce inflammation and therefore pain coming from nerves and other structures in the back. Sometimes a lumbar epidural or a nerve root block are more appropriate treatments. Your Bath Pain Management consultant will explain to you the most appropriate treatment for your symptoms, based on a consultation where you can describe your problem, and possibly following an MRI scan of your back.
A caudal can provide meaningful pain relief in around 75% of patients. After a caudal you can expect pain relief to last anything from a few weeks to many months. Occasionally pain is relieved, and does not return. In this situation, the nerve root block has probably tided you over long enough for your body to heal itself.
We perform many such injections each year with no complications. However, as with any medical treatment, there are some risks that we will discuss with you. Specifically, we will mention:
a risk that the treatment will not work for you
nerve damage (on average this happens about 1 in every 10,000 injections. It is rarely permanent)
headache (around 1 in 200 injections or less)
if you are a female patient, you may experience abnormal vaginal bleeding following a steroid injection anywhere in the body.
very rarely, steroids used by any route (eg by mouth, inhaled, injected) can cause visual problems. If you have any visual disturbance following a steroid injection, you will need to be seen by an eye specialist to rule out any serious cause.
BEFORE YOUR TREATMENT
Our usual practice is to see for a consultation before your injection so that we can go through the best treatment for you, and detail it's risks and benefits. An exception to this might be if you have had a similar treatment before and are coming for a repeat injection. It is extremely important that if you take any drugs that affect your blood clotting (eg warfarin, heparin, dalteparin, apixiban, clopidogrel etc) that you tell your Bath Pain Management consultant or our administrative team prior to the day of treatment, as there are some injections that we cannot perform whilst you are on those drugs. We will be able to give you tailored advice regarding arrangements for your medication around the time of your treatment.
We will endeavour to send you detailed information on any fees that apply before you come for your treatment. Again, please contact our administrative team of you have not received this information before the day of treatment.
ON THE DAY OF YOUR TREATMENT
On the day of your treatment you will be asked to attend the hospital a little while before the time of your injection. This is so that the nurses can get you ready for your treatment, and your Bath Pain Management consultant can see you to go through the treatment again and give you the opportunity to ask any questions that you have. Having gone through risks and benefits of the treatment again, you will be sign a consent form for the treatment, giving us permission to go ahead. However even after you have signed this you are perfectly entitled to change your mind at any time.
WHAT HAPPENS DURING THE TREATMENT
You will be asked to walk to the room where we will treat you. Sometimes you may go to the room on a trolley or on a bed. There will be a number of staff present in the treatment room including your consultant, one or two nurses and a radiographer. The radiographer's job is to operate the xray machine for your injection. You will be asked some questions as part of a safety check. When this check is completed you will be helped into the correct position for the treatment. The consultant may perform some xrays at this point, then the treatment will be carried out. Prior to the treatment some local anaesthetic will be injected that will sting for a few moments, but following this the treatments are often quite painless. Occasionally, particularly if you have had pain for a long time, the treatments can be uncomfortable, but your consultant will endeavour to reduce any discomfort to a minimum.
On rare occasions, we may offer you sedation for your procedure. Generally this is not necessary, and there are benefits to avoiding sedation if possible.
WHAT TO EXPECT AFTER THE TREATMENT
After a caudal, you may have to spend 30 or so minutes in the recovery area having your pulse and blood pressure monitored. This is routine. You will then be moved back to your room. Once you have mobility after the treatment you will be able to go home. You will be unable to drive yourself and will therefore need to make arrangements to be collected and accompanied home. Most of our patients are able to leave the hospital within an hour to an hour and a half of having their treatment.
FOLLOW UP ARRANGEMENTS
If you are a private patient you will receive a telephone call to check on your progress within three to four weeks. Please note that we are unable to leave answerphone messages for confidentiality reasons, unless your answerphone clearly states that you are the owner and we have your permission. You may be invited back for, or request a follow-up consultation to go through other non-injection treatment options.
We see a small number of patients through the NHS Choose and Book system. Generally follow-up would be provided by your GP, but we are obviously always happy to deal with any concerns you may have after your treatment.
*A note on the use of steroids in spinal injections
Although steroids have been used for many years safely in spinal injections, they are not licensed for this purpose. This means that the companies producing the steroid have not paid for a license allowing them to market the steroids for spinal injections. It does not mean that doctors cannot use them for this purpose when the symptoms suggest they would be useful.
Your Bath Pain Management consultant will be happy to explain this in more detail to you if you wish.