Caudal Epidural

The procedure is a day case and you won’t need a general anaesthetic. The procedure is usually done under local anaesthetic, sometimes with sedation if needed. The injection itself usually takes 10 to 15 minutes, though you’ll be at the clinic for longer to allow for preparation and recovery.

Here’s what to expect on the day:

1. Your consultant and anaesthetist will talk you through the procedure, answer your questions and ask you to sign a consent form.

2. Once you’re in the treatment room, you’ll be connected to some monitoring equipment to measure your heart rate, blood pressure, and the oxygen content of your blood.

3. You’ll have a needle or ‘drip’ placed in a suitable vein, usually in the back of your hand. This is to deliver the pain relief.

4. Then, you’ll be turned to lie face down on your tummy in a comfortable position.

5. Your consultant will clean the target area on your back with an antiseptic solution.

6. Next, you’ll have local anaesthetic injected into your skin to numb the area where the caudal epidural will go in.

7. When your skin has gone numb, your consultant will give the caudal epidural injection, using ultrasound or X-ray guidance to position the needle safely.

8. If you feel discomfort or sensations of pressure, leg numbness, tingling or burning, or a buzzing in your ears, this is common, but tell your consultant, and they can slow down the injection. If you feel pain, tell them so they can manage it as well as possible.

9. Once the needle is in the correct place in the epidural space, your consultant will inject a single dose of medication, remove the needle, and put a dressing over the injection site.

10. You’ll then be positioned comfortably to go through to the recovery room.

Overall, caudal epidural injections are very safe. As with all injection procedures, there are some risks. 

Common after effects include:

• bruising of the skin and under the surface

• a fall in blood pressure that can make you feel lightheaded or dizzy – fluid or medication can help

• feelings of nausea or sickness that can be eased with anti-sickness drugs

• mild to moderate discomfort that can be treated with small doses of painkillers via a drip

• a ‘dead legs’ feeling of heaviness and difficulty moving, that usually wears off over a few hours

• temporary urine leakage if your bladder nerves are numbed by the local anaesthetic

Rare complications include:

• breathing changes are very rare and are usually managed quickly with simple measures such as adjusting your position or giving oxygen

• a severe headache that lasts for a few days. This happens in about 1 in 10,000 people – you would stay in hospital for treatment while it lasts

• bleeding or infection

• prolonged increase in pain after the procedure

• allergic reaction to any of the medications

• nerve damage and weakness

• worsening of your pain, or a new pain that is difficult to explain

Before the procedure, we’ll make sure you feel as comfortable as possible and give all you the information you need.

Your consultant will tell you which medicines you should either stop taking, or take, in the days leading up to your caudal epidural injection. For example:

• if you’re on any blood-thinning medication such as aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, or dabigatran, your consultant may adjust your dose

• if you have diabetes, the steroid may affect your blood sugar levels, so getting good control ahead of the procedure is key

Tell your consultant as soon as possible if you:

• have any allergies

• have an infection

• have had a recent steroid/cortisone injection by another doctor/nurse, or if you have regular steroid joint injections

• have had a recent heart attack or vaccination

• could be pregnant

You may need imaging tests before your procedure, including ultrasound, X-ray or MRI.

On the day, do not eat (this includes chewing gum) or drink for 6 hours before you’re due to have the procedure, or it might need to be delayed or cancelled. If you have diabetes, talk to your consultant about the best approach.

You’ll spend some time in a recovery room to allow your consultant to monitor you for any side effects and make sure you can pass urine. Once you’re ready to leave – usually within 30 minutes to a few hours – you can go home.

Some key things to note on the first day:

• don’t drive or use public transport to get home – have someone with you to get you home, and ideally to stay with you overnight

• rest for the remainder of the day – you’ll likely feel tired

• for 24 hours after the treatment, don’t drive, drink alcohol, operate machinery, sign legal documents, or provide childcare on your own

• keep the injection site dry for 24 hours

In the following days and weeks, be aware of these things:

1. It’s normal to feel an increase in the level of your pain for a few days – you can continue to take your normal pain medication or pain relief as agreed with your consultant.

2. It’s not uncommon to experience unusual sensations for up to 1 week after the caudal epidural.

3. For any bruising, apply an ice pack wrapped in a towel.

4. If you have diabetes, you’ll need to monitor your blood sugar levels carefully for several days after the procedure, as steroids can interfere with your blood sugar control. Tell your consultant if you notice changes or have difficulty controlling your levels.

5. If you have heart failure, you may experience increased shortness of breath due to salt and water retention. Contact your consultant if you have any problems.

6. Some women may experience irregular periods for 1 or 2 cycles, or post-menopausal bleeding that resolves quickly. This is due to the steroid.

7. Try to keep moving gently, doing your normal activities. Your consultant and physiotherapist will tell you if there are specific exercises you should do.

8. Tell your consultant about any signs of infection, such as warmth, redness, or tenderness at the injection site, or if you feel hot and unwell.

Our consultants will always arrange for you to have a follow-up consultation where they’ll provide the best personalised pain management for you. This will be to discuss:

• how well the injection worked for you

• future pain management approaches based on your results, which may include more caudal epidural injections if it worked well for you, or other treatment options such as physiotherapy or different procedures

Please contact our Pain Medicine centre for pricing information.

At Welbeck, our pain medicine specialists are experts in their field and are dedicated to providing world-class care to every patient.

With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.  

All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.

To book a caudal epidural, you must be referred by either your GP or a specialist managing your specific kind of pain, following a consultation with them. Self-referrals are not accepted for this treatment.

If you would like to schedule a consultation with a pain medicine specialist, please get in touch to make an appointment. Your health is important to us, so we strive to offer same-day appointments whenever possible.

Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. Learn more about the different payment options at Welbeck.