An epidural steroid injection places this powerful anti-inflammatory medication directly around the spinal nerves. Traditionally epidural injections were administered without any special equipment, by inserting the needle by feel in the area around the spinal nerves. More recently epidural injections have been administered with the aid of imaging tools to allow your physician to see the needle going to the proper location. Either real-time x-ray called fluoroscopy, or CT scan can be used to 'watch' the needle deliver the medication to the proper location.
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.
Once the surgery is finished and the child is awake in the recovery room, parents may be called to be with them. Often a child will cry upon waking from an anaesthetic and there are multiple causes for this, including waking in an unfamiliar environment, pain and sometimes "emergence delirium" (confusion), which can be caused by anaesthetic gas. Children with this condition may be agitated, restless and confused. The condition resolves and improves with time, but may need an anaesthetist to administer medication to settle the child.