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ESI's while awake???

HollieSterling38HollieSterling38 Posts: 390
edited 06/11/2012 - 8:36 AM in Pain Management
Please someone tell me how this is gonna feel!!!
I had esi's before but was put out for it. This is my lower back and sciatic issues. My last pm had to go in through my tailbone area becuz of the fusions and all going on there and I remember the aweful pain when I first woke up, which subsided pretty quick. But being awake!!! I'm kinda scared!
I've had pp injections which actually were quite tolerable compared to existing pain, but this is gonna be different.
Anyone been awake for this? I know my aunt and a friend have and my aunt went into seizures and my friend said it was the worst thing she ever went through. Please tell me something good! I'm freaking out over it.
I'm having this done soon, thinking maybe my appointment the 13th, not sure exactly when yet.


  • Cuz I woke up in recovery. If they sedated me with whatever it must have knocked me out cold. But she said I wouldn't be knocked out for it.
  • dilaurodilauro ConnecticutPosts: 9,842
    I have had almost a dozen ESI's over the years. These were done by 3 different doctors. In each case, I was sedated, never under.
    The doctors explained to me, that while the procedure was going on they wanted to be able to talk to me.
    The nurses in the room were also keeping a close look on my vitals during the entire procedure.
    Like Paul said, I have never heard of anyone being put under for an ESI. We have had 1000's of posts over the past 4 years talking about ESI and no one has ever mentioned that. Some have said that they were not sedated and some the doctors did not use a fluoroscope.
    But the standard accepted practice in doing ESI's is to have the patient a- Slightly sedated and b- Use of a fluoroscope to guide the 2 needles
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • Hi Hollie,
    I have had them only in neck area and was never sedated.
    Hugs to all..Patsy
  • Then how'd it feel?? I remember the pain afterwards like a bad nightmare. It was aweful, so how'd it feel during the proceedure?
  • I had them done while awake, sedated.
    My one suggestion is to tell them how scared and or panicked you are at the time of the procedure. They should be used to dealing with it and give you "extra" to help calm you down.

    I have to take valium to get an mri, well I used to, now I can't have them....darn L)

  • I had it in neck before and it was useless. This is fir lower back and sciatic, the last ones I had there worked longer than usual, and gave me relief. It's wore off and I hope I get the same result. I can barely walk or drive with the pain.
    Thanks for your reply!
  • Thanks! I am defenitely having anxiety bout it and will sure let her know.
    I don't know why I'm freaking out other than the after pain when I woke up before.
    I usually don't panic, but being awake is really scaring me.

  • So how'd it feel???
    I was out cold or atleast out of it.
    I woke up in recovery.
  • DDo you know what type of injection you are having? I think what you were referring to earlier is the caudal injection which goes in very low in the sacral area.

    I have had many lumbar injections and nerve blocks, both with conscious sedation and without. My new PM doc does not use sedation. I have had four procedures with him and I have had four different experiences.

    If the doctor finds the right spot, you will probably have pain for a minute or two that is intense. After the actual injection, you may or may not experience pain. I'm not sure what accounts for the variations in the same procedure, but I have never experienced the same reaction twice. Sometimes there is pain afterwards; other times I have been comfortable.

    Try not to be influenced by what experiences you have had before. You might want to call the office and discuss your fears and anxiety with them. Or perhaps you could switch to a different doctor who will sedate you for the procedure.
  • I have had them 3 different ways. My first Dr did them using versed in the hospital, but I was pretty much awake, didn't remember much afterwards. Then I moved and the next Dr. did them in his office when I was fully awake. For those I did have intense pain while he was doing them, but it eased up after he was done.

    For my current Dr. most of the time I was fully out because I also have woken up in recovery very shortly after them. Obviously, this was my favorite way to have them.

    I would explain your fears to the Dr's office and see what they can do to help.
  • I would much rather be sedated. Usually, I would be so darn tired due to lack of sleep that the minute I was "relaxed" I'd be out like a light. I even told the fella that took care of my IV "Hey there cowboy - easy on the happy juice - I want to be able to watch!" but wound up being woke up by my doc.

    Now the one without sedation? Oh no no no no no no NO NO NO no NO! NEVER AGAIN! Talk about hurt

    I hope you have a choice Hollie. If not ask for something to relax you. Better yet, INSIST on it.
  • I was not sedated. They used a fluoroscope to guide.
    I have had three and all done in cervical by same Doc.
    I was not nervous.. but if you are diffidently ask for something.. I had to lay still on belly with a nice comfy place for my head to relax in. because there was not much room up in neck to insert they had to lower head some.
    During one of the times... I actually felt what seemed like hot liquid (which was medicine)running down inside of my arm to my hands and was able to talk and told him and he said that was okay.
    This was about 4 years or so ago.. hard to remember everything.. But I know I was still working at the time and when procedure was done. I had to rest in a room for about a hour or so to make sure my vitals were okay and I did not get headache. Then I drove myself to work for the rest of the day..
    I had a spinal tap year or so later and would of given anything for them to have been able to give me sedation or knock me out for that..
    Back to ESI I'm not sure if I was ever offered anything to calm nerves or twilight med's because I'm sure I would of said Yes Yes Yes. I have enough pain don't need no more.. you know what I mean..
    But at that time I knew very little about spines and problems in neck. But I don't remember to much of being uncomfortable with the procedure.
    If I had it done again i would ask for some twilight meds just because I know more. And I'm more nervous with anyone messing with my neck or back.
    Hugs all...Patsy
  • Is all I know and he had to start that low becuz of fusions and all.
    Thank you for your reply!
  • Thank you! I'm most definitly am gonna insist... Or have a heart attack from fear, LOL but seriously. That pain afterwards was pretty intense before.
    It calmed down after an hour in recovery, but not completely for a day or two.
    You two have a god day and thanks again.
    I want to know the truth, know what I mean?
  • Thank you!
    Im not afraid of anything that's gonna help, just the pain.
    I'm use to all the shots in my spine, just this is not one of them.
    Like pp shots, they feel good compared to my pain and if I was able I'd give them to myself. This I'd rather be be out of it. But will insist on something to help!
  • dilaurodilauro ConnecticutPosts: 9,842
    Here is what a Normal ESI should go like (Regardless of spinal location)

    1- Arrive at the Center with a driver.
    2- Complete all your paper work, Id braclet, etc
    3- Brought into a pre-exam room, where you are given the hospital gown. All vital signs are taken
    4- The doctor comes into explain the procedure to you, should mark the actual area on your spine where the injections will be given and answer any of your questions
    5- Rolled into an Operating room like facility, completely sanitized along with your doctor and a team of nurses.
    6- You are placed on the table, stomach down, pillow underneath. Your vital signs are taken again
    7- An IV is started to provide you with a mild sedative (you need to be awake during the procedure)
    8- The doctor explains what he is going to do
    9- Nurse continue to prep you and the area
    10- Doctor waits for sedative to take.
    11- Doctor using the fluoroscope inserts the initial needle.
    12- Then using the fluorscope the doctor inserts the major needle.
    13- Needles removed
    14- Area cleaned up
    15- Whole procedure up to this point about 20 minutes
    16- Rolled into a recovery room
    17- About 15 minutes later, vitals are taken again
    18- You are offered cookies, crackers, soda, etc
    19- Vitals taken again
    20- Nurse explains what to expect for the next 48 hours
    21- You are given papers explaining everything to take home.
    22- Assuming your vitals are still ok, you will be released to your driver
    23- First 12 hours, the injection area will be sore
    24- Next 12 hours should be uneventful
    25- Next 36 hours you may or may not see any improvement, you should NOT see any additional pain or discomfort

    I think I could do all of this with my eyes closed since they have become so routine
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I've already had 4 of them, just was out cold to my knowledge.
    2 in neck which was useless and 2 in L/spine which was very successful and then some.
    I asked her if she would be sedating me she said no. I'm thinking ok this is gonna freaking hurt. I know before I was sore for the first couple of days but it was tolerable except for recovery right afterwards. Then the relief set in.
    Maybe she just failed to mention any thing thats gonna make it ok to just freak me out I guess, if so she's not very funny!! Maybe she was trying to be???
  • Ron,
    That's sounds like the right way it should be done.
    I know I had mine all done at the spine clinic in Rockford IL. but I never had a IV put in. now they probably numbed the area in my neck where they inserted the needle. I know they used the fluoroscope.
    But all the times I drove myself and I drove myself home or to work.
    They did take vitals often after procedure And gave me snack food.They knew I drove myself and even knew I was going to work after the one time because I had put my scrubs on and told them I would be doing mostly paperwork.
    I did have a issue after last ESI.. but that's for a different day.

    Hugs to all..Patsy

  • My PM does them exactly that way. As long as I had the versed, I had no problems the first 12 hours. Until the initial meds wore off. Around day 2, I would have a little discomfort, which would increase through day 3 and 4, then begin to subside. By day 5, my pain levels would be back to normal 4-5 on the pain scale (without activity; with activity, it would be anywhere from a five to an eight).

    However, on the day I had no sedation (because I was called to reschedule my appt - they wanted me to come "that day" although I had no driver lined up. This was because of a holiday that I was assured the office would be open when I scheduled the original date) They assured me I would not need a driver if I did not have the sedation.

    When I say that hurt, it hurt during the procedure. After the procedure, no amount of ice packs or heat, or medication would take away the pain. After the first 12 hours at least it began to subside.

    At my follow up appointment, I told my doc under no circumstances would I be doing that again. She told me she has patients who do it without sedation each time and have no problems. I told her I was not a masochist.

    I think that anyone who can do that without sedation is a super being of some sort. And my hat's off to them.

    i hate pain - especially the un necessary kind
  • Mine went about like Ron said and, frankly, I think it's overkill with the IV, resting, hospital bed, etc. It seemed so easy that I feel like I should just walk in, pull down my pants, get the shots and go back home.

    My injections was completely painless, except for the shooting pain down the back of my legs afterwards that was gone by the next day. They said that they sedated me with versed, but I remember the entire thing and felt the same as when I walked into the pre-op area.

    Hollie, there was 0 pain during the procedure. I hope it's the same for you - the easiest procedure I've ever had done.

    Good luck.
  • I'm wondering if we're talking bout the same thing here, LOL
    Cuz mine hurt like hell afterwards so I can only imagine the during!
    Thanks for all the replies, I'm insisting on some kind of comfort through it!

  • I'm going in for medial branch nerve blocks on the 15th and I'm going to ask for more sedation than they gave me for my first injections. I'd like to not remember a thing, thank you very much.
  • Pressure, burning and pain. No sedation. Steroid flare. Miserable. Will never do it again!

  • that's what I'm talking bout!!!
  • Cath111 said:
    It seemed so easy that I feel like I should just walk in, pull down my pants, get the shots and go back home.
    That's closer to how my doc does them than to what Ron described.. :))(

    Hollie, you might want to do some research on autogenic relaxation. If you can teach yourself to do it, it's almost like "self sedation" without the drugs.
  • I have had at least 6 in the cervical spine and I think two i was wide awake laying there thinking this is gonna hurt but for the two that i was awake it wasnt horrible. I could feel the needle go in and i just kept thinking any moment it would get worse but it wasnt as bad as i thought it was going to be and i did find it interesting to be awake and actually know and see what they were doing, so maybe my attention was drawn to watching and not concentrating on the pain i dont know but it wasnt a bad experience for me and I hope it wont be for you either.

    Every person is different and every injection is different and you just dont know how it is going to feel or affect you until its done. I stressed over the first one also so much it made me sick then when it was done and it helped i couldnt imagine not doing it even though they give me a headache.
  • My ESI was without sedation. Wasn't horrible at all. The only intense time was when they injected the medicine and it hit the nerve root, replicating my symptoms exactly. This only lasted about a minute or two, just breathed through and it was over.

    I have had 4 different facet blocks. One with sedation, 3 without. Getting an IV started on me is not easy, and to be honest, that was worse than just doing it without the sedation. You will feel a sting and some pressure, but if you stay calm and let it pass, it really isn't too bad. I've also had an injection into the bursa of my hip; same thing, no sedation with the same experiences. Yes you'll feel the medication being injected, but it isn't horrible.

    If you are going to have post procedure pain, you'll
    have it whether you are sedated or not. I like to be alert and listen to what is going on. You'll feel a stick when they first insert the needle. It is cool to see the monitor as they advance the needle a fraction of an inch, take an xray to make sure of positioning, advance again, snap the xray, and repeat this until they are certain they are in the correct spot to inject the medication. If my memory is correct, they first inject dye to see it spread on flouroscopy, and then they inject the medication. You'll feel them advancing the needle, but it isn't painful, just pressure.

    With all you have been through, you will do just fine. The key is to just stay calm. But if you are too freaked out, request the versed or a shot of something for your severe anxiety.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • I will look it up thank you!
    But it just sounds like something that I could do and not get a shot, LOL.
    But I will look and let you know how that goes!
    Thanks for replying!
  • Thank you fir the replies!
    I will keep that in mind.
    What is the bursa? Not sure.
    I know I've already been through alot, but I'm thinking she just didn't explain her way all the way except the no sedation. I'm gonna call and ask the game plan today. So I do know. Maybe she thought in some sick way it would be fun to just scare me!! Not funny if so. I don't lie to joke bout stuff dealing with my spine!
  • Esi's and nerve blocks have all been h#ll for me.I have been awake for all of them! My last cervical nerve block was in 2002 and sent me into a severe flare for 2 weeks. I was completely siezed up! I decided then that I would no longer allow the torture of my body. And the steroids never helped anyway. I have refused all spinal injections and EMG's since 2002, and my surgeons are okay with that. I've been told I have fibromyalgia, this could be why injections are so tough on me.I wanted to be honest with you! Sorry if I scared you.
    Faith M
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