Are spinal injections done awake or under sedation?

Every spinal injection and ablation in this office is done with the patient awake, under local anesthetic at the skin. We don’t use sedation, because your feedback during the procedure is part of the procedure: the brief reproduction of your leg pain as a needle nears the root confirms the level, and the sensation you report as a radiofrequency probe is tested tells us it is sitting where it should. A sedated patient cannot give that information. The by-product is that there is nothing to sleep off. Recovery is two to four hours, most of it spent at home, and normal activity including work resumes inside that window.

The exception is kyphoplasty, which uses mild sedation. For that one a driver is required and the recovery guidance is its own. Everything else on the procedures list, epidurals, facet and sacroiliac injections, medial branch blocks, radiofrequency ablation, stimulator trials and peripheral nerve stimulator placement, is done awake.

Why can a spinal injection make your leg numb?

An epidural or a transforaminal injection places local anesthetic (numbing medicine) near a nerve root before the steroid goes in. In some patients that root carries the nerve fibers that move the leg. The result is a leg that feels heavy, warm or numb for an hour or two, occasionally a little longer. It is expected, it resolves, and it is the whole reason the question of driving exists. A retrospective series of fluoroscopically guided lumbar transforaminal injections looked at the problems that occurred. They were minor and short-lived: headache, a flare of back pain, a vasovagal episode (a brief faint or near-faint). That pattern matches what we see. A heavy leg is not a complication. A heavy leg on the brake pedal is a problem, so it is checked before you get to the pedal.

How do you know it is safe to drive home after a spinal injection?

Two things worth knowing for the drive

The steroid in an epidural raises blood glucose for several days. In a diabetic patient the rise is measurable. Two clinical series in diabetic patients found glucose high for days after epidural steroid, and the effect grew with the dose. If you are diabetic, check your sugar that evening and the next morning. Treat a high reading as expected, not alarming, but tell us if it stays high. Also, the relief you feel in the first hours is the local anesthetic, not the steroid. The steroid builds over days. A block that feels wonderful at hour one and ordinary at hour four has done its job. The steroid effect is judged at two weeks, not at the toll plaza.

Which steroid was used matters to the choice of route rather than to your drive: particulate and non-particulate preparations perform similarly in the trials that have compared them, and the practice chooses the one that suits the approach and the level.

Common questions

Related reading

• Epidural steroid injection
• Radiofrequency ablation
• What a diagnostic block tells you
• Your first visit from Illinois
• Kyphoplasty