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Old 04-23-2009, 04:45 PM   #1
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Epidural steriod injection vs. nerve block

What is the difference between these two? I have already had the epidural injections and it sounds like the nerve block is similar, so what's the difference?

brian

 
Old 04-23-2009, 06:35 PM   #2
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Re: Epidural steriod injection vs. nerve block

An ESI contains only cortisone or another similar substance to reduce inflammation, so it is therapeutic only.

A selective nerve root block, on the other hand, contains both cortisone and a numbing medication (similar to novacane you get at the dentist) to numb a nerve root. By numbing a nerve root as it exits the spine, the doctor can determine if that level of your spine is causing your pain because if it is then it will go numb along that nerve root for around 3 hours before it wears off. So a SNRB is both theraeutic and diagnostic. Also, if your spine at that level or a level nearby is causing your problem, you should have some pain relief for a few days up to a few weeks afterwards from the cortisone.

HTH!

 
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Old 04-23-2009, 11:16 PM   #3
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Re: Epidural steriod injection vs. nerve block

There are multiple kinds of epidural steriod injections. They are all commonly referred to as epidural but the procedure to the doctor is slightly different. There is an interlaminar epidural injection (which is in the epidural space) a more general regional anesthetic, in the lumbar they refer to the interlaminar type as "caudal epidural". There is a transforaminal epidural (which is at nerve root). The transforaminal epidural is commonly referred to as nerve block.

The interlaminar Epidural Steroid Injection is an injection of long lasting steroid ("Depo-Medrol/Triamcinolone/Celestone") combined with a quick acting anesthetic into the Epidural space, the area which surrounds the spinal cord and the nerves coming out of it.

Where the transforaminal(nerve block) is when a long‑acting local anesthetic agent typically (MARCAINE) combined with a "steroid‑type" agent (Depomedrol, Triamcinolone, or Celestone) is injected adjacent to the affected nerve root(s)'s dura.

As far as the procedure to you the patient is all goes about the same, although I think the nerve block type is a tiny bit more painful to me at least. I have had over 25 injections.

 
Old 04-24-2009, 12:17 AM   #4
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Re: Epidural steriod injection vs. nerve block

I agree with NP as far as the nerve blocks being more painful - when they hit my thoracic nerve in the right spot, I just can't explain it. I jump and start twitching (2 lovely nurses that work with the pm hold me still - not so sure that they're that lovely actually ). It is only with the T8 nerve that was crushed that I respond like that though. He does T7 and T9 on both sides also and they are ok, a little bit sharp but ok. If the nerve isn't too damaged, it shouldn't be too painful.

I have also had a spinal block (around the cord in my upper thoracic) once before my surgery and that wasn't painful - just weird. I don't think that this is what you're having though? I was in the ER because I my diaphragm was spasming because of my thoracic injury and this was how they stopped it so I could breathe properly (they tried some other meds etc first) - I also had to stay in hospital for a while. When I hear epidural block - this is what I think of because that's how we refer to it in Aus. Otherwise it's a nerve block at the root of the nerve.

I think that the other posters described it very well. I'll be thinking of you on the day.

 
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