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ESI with no sedation?

sunny1966ssunny1966 VIRGINIAPosts: 1,385
edited 06/11/2012 - 8:42 AM in Spinal Injections
I am scheduled for my first ESI on March 12. I asked if he uses any kind of sedation and they said no. Is this normally done without any sedation? I don't have any pain meds to help me through (except some muscle relaxers) or even afterwards unless he gives me some that day. I've never met the doctor. I saw the NP. I'm not looking forward to this at all. Maybe if I dread it enough it will seem like nothing when the time comes? lol. I'd just like to know how many of you had the sedation or not? Thanks.



  • It seems to vary from doc to doc whether they use sedation or not. I have not had any sedation for ESI or any other type of injection/block. Others seem to get it at the drop of a hat.

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    That's the same thing I was thinking about pain meds. I've only had Tramadol, Flexeril, and Norflex and they don't do a very good job. That's all my GP will prescribe and he says I need to stop the Tramadol. I've ran out of refills so I need to get in to see him again. I thought that the PM would give me something yesterday. It was my first visit to one and I didn't want to ask. They gave me Lyrica and a couple of Lidoderm patches. They also want me to get a tens unit. I just don't understand why they don't give me something. I can't take anything really strong without taking anti-nausea meds so it's not like I'd take to many. Sorry to go on so much there! I get very discouraged sometimes.
    Hope you're having a nice day.
  • I've found there does not appear to be any "normal" when it comes to spinal procedures. It seems to vary from doctor to doctor. Since 2005 I have had 3 different PMs. Two would ask if you wanted twilight sedation. My current PM does not as he wants the patient alert to answer questions or respond as he goes. Oddly enough, the only time I have had a response to an ESI or nerve block is with the doc who does not sedate.

    They do use a numbing agent as they are inserting the needle so it isn't too painful. If you do get a zap as the medication goes in, it only lasts a couple seconds.

    If you are really worried about this, perhaps you might want to look for a different PM or physiatrist.
  • I, too, am getting a little bit nervous about having my first nerve block and coccyx injection. My tailbone is just screaming mad these days and any relief would be a wish come true.

    I have a consult appointment on March 15th with the Physiatrist, who will be doing the injections. (My PM doctor, my PCP and my Orthopedic Surgeon have all given high praises to this Physiatrist... which is always good to hear).

    I see my Orthopedic Surgeon this Monday, to go over the CT scan done last Monday on my pelvis. I have the results and I have learned a lot of new terminology. "Calcified phleboliths" are seen within the anterior inferior pelvis, but my PCP assured me these are nothing to worry about and are commonly found.

    It's nice to read the input from "C" and Gwennie.

    Please don't feel like you are "going on" about your pain. You hurt, you're in pain and this is the place to share your feelings and get input and support from other members.

    Do you have another appointment set up with this new PM doctor? If you could chart your pain over the next month and bring the logs with you on your next visit, the PM doctor might suggest something else to take for your pain. When your pain spikes, write down what medication you take and the level of relief you feel from that medication. I chart mine on a 24 hour basis and include all activities and exercising I do. BionicWoman has a great link for a pain chart to use, which you may find helpful.

    I will be wishing you the very best success with your injection.

    Thinking of you and wishing you less pain, my friend!

    I'm nervous, too.

    Tammy :)

  • On March 4th Im going for another ESI. The ESI I recieved on Jan. 14th is starting to wear off. The doctor wants to bathe the nerves with more Betamethasone before the first injection wears off completely.

    I told the doctors nurse that I do not want sedation because I cant find anyone to drive me home after the procedure. She said that would be ok.

    Per Gwennie:
    They do use a numbing agent as they are inserting the needle so it isn't too painful. If you do get a zap as the medication goes in, it only lasts a couple seconds.
    Exactly Gwennie, and thats why I dont need to be sedated. Its not a long painful procedure, and Im not nervous or anything like that. Not depending on someone to drive me there and back is a relief as well.

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I won't lie, I am nervous about it. I know it'll problably be okay but I'm a worrier. I'm usually pretty tough when it comes to pain though. I'm sure it can't be much more painful than an injection I had in my foot between the toes!(can it?) That one brought tears to my eyes! Still, I'll worry until it's over. This PM is the only one near here that accepts our insurance so I'm pretty much stuck with them. Please keep your fingers crossed that the injection will give me some relief okay? Thanks

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I hope that you get some answers from the ortho Monday. I know how much pain you're having. I'm sure you're getting nervous about the injections too. I hope they give you a lot of relief. I know what a pain in the a@@ (pun intended) tailbone/sacrum pain is. No fun at all!

    I have an appointment March 10 to discuss the Tens unit. I don't know if I'll see the doctor that day either. I wish that sometimes they'd cut out the middle man (NP or PA) and let us see the Dr before procedures.

    Thanks again for your concern Tammy. I hope you are having a nice weekend.

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I hope you get relief from your next injection. Maybe it will last longer than the first.
    I've been thinking of all the things I've had done through the years and I guess this really won't be so bad. It's just the thought of it being in my neck because it's always so painful, sore and burning anyway. All of you are right, I'm sure it won't be as bad as I think.

    Good luck with your next procedure.
  • Hi Debbie. I was completely sedated for my caudal ESI and I liked it that way. At first, I thought it would be overkill for such a small procedure. But in the end, I liked not knowing what was going on. That way I wouldn't be freaked out about another one if I needed it. If you're nervous, you should ask for some valium/other. Good luck with your injection!
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I will ask the doctor about it (whenever I see him). How are you doing since your injection? Is it working? I hope so.
    I hope you're having a good day.

  • I don't know how much it worked. I had my injection 11 days ago and my work days have been a bit easier. I certainly didn't get 100% relief, but I feel better than I have in a few months. Doc says it can continue to help. Just have to wait and see. I think my disc was starting to heal a bit already, so maybe the injection was an extra boost. I probably won't get another one. For $2200 I didn't get THAT much of a boost.

    Have a great weekend!
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I'm glad that it helped you a little. Hopefully it'll last a long time. I didn't realize they cost that much! I have to go to a day surgery center for my ESI so that means there'll be an additional facility charge. The facility isn't in our network either so I can end up paying pretty much after insurance. God I hope it works or my hubby will have a fit. lol. Do you know if the ESI costs about the same? Thanks.

  • I'd say anywhere from $2,000 to 3,000 is a fairly common amount. I didn't really notice much difference between various injections, nerve blocks, caudals, etc.

    I've only had "precedures" in my lumbar spine, so I hope I am not misleading you. Ask him why he will not give you any sedation. It's always interesting to hear their reasoning.
  • j.howiejj.howie Brentwood, Ca., USAPosts: 1,730
    Hi Debbie, When I was getting the steroid injections before my first surgery. My P.M. Dr. was set up to do them in a part of his office. On an x ray table In a small room. He would give me a mild sedation. I have "white coat syndrome" and even after the sedation, I would practically tremble right off of the table. That dosen't work for him. So he gave me another. He says he has to be verry precise. I have a high tolerance to all of that stuff, it just dosen't do much for me. He was very good at putting it right where it needed to be. And he would tell you ahead of time. To stay off of your feet. and try to stay off of your feet for at least 24 hrs. I had a friend that first told me about the benefits of the ESI.s and he said he liked to get them on a Friday. So he could stay off of his feet all weekend. He had such great results. That I did the same. My P.M. Dr. would say, don't stand, because I don't want all of that stuff leaking out. Now I have never herd anyone on this forum say that their Dr. required that. But I had excellent results doing that for 4 yrs. And most, I hear from on this forum don't seem to get the good results that I did.( they allowed me to get a extra 4 yrs.) Before I had to have surgery.
    When I got nerve blocks by a different P.M. Dr. He didn't give any sedation. And he did them in a out patient surgery center.
    Good luck, Jim
    P.S. The ESI.s really weren't that painful.
    Click my name to see my Medical history
    You get what you get, not what you deserve......I stole that from Susan (rip)
    Today is yours to embrace........ for tomorrow, who knows what might be starring you in the face!
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385

    I think the lumbar and cervical would probably be the same. It's ridiculous isn't it? Thanks.

  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I wondered if they want you to take it easy after them. I thought it would be kind of like when you have a myelogram. They don't want you to lay flat for 24 hrs. I'll take your advice though because I want it to work...the first time hopefully.
    How are you feeling Jim? I hope you're getting along well.

  • I'm going Wednesday for an ESI with my new PM Dr. This will be my 6th one since last year and hopefully with better results. There's no sedation for me just a numbing agent is used first. I take a mild sedative and painkiller before I go in though.
    I will also take it easy for 2 days after. Last time I walked 2 blocks around the house because my leg pain was so much improved. But this time reading Jim's post I will take it easy afterward.
    I do some deep breathing through the procedure to get me through. I hope your injection goes well. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Debbie,

    The breakdown of my costs: doctor's fee $1050, facility charge $1150. That facility charge is discounted at 30% b/c I'm uninsured. I'm not sure what part is usually covered by insurance. I hope it works for you. My doc said it had a 50/50 shot of working and I thought the ESI was worth a try (although expensive).

    Btw, after my injection, I did almost nothing for several days.

    Good luck! Let us know how it goes.
  • Stansoup.....PLEASE be very careful if you do not have a driver after your injection!I know most times it is ok to drive even after sedation from an injection such as the ESI BUT and a very big but!You could possibly go numb in your legs after getting the shot!Then you would be helpless.I have seen this happen leaving my PM doc's office.A lady drove herself and lied about a driver,got in her car and lost ALL feeling in her legs and feet.Yes, she was already in motion with a moving vehicle.She almost caused a terrible accident and could have killed herself or anyone else.She had to come back into clinic until she could walk again.She was lucky the cops didn't arrest her for trying to drive like that.I know it's inconvienent at times but please get a driver,to be safe.I am a worry wort!My old pm's office made the driver sign a form and ALL injections were done w/ knowledge of a driver first.People who lie make it hard for the rest of us.I know you haven't lied, you were honest but a lot try to get away with things.Again, making hard on the rest of us.
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I agree that it is worth a try. I'm kind of getting desperate for help. I'm very lucky to have insurance but the copays and deductibles really add up especially when we pay so much for the insurance every week too. Bills are what makes my world go around...supposed to be love isn't it?? :? 8}

    Hope you have a great day!
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I hope your injection goes well and provides more relief than the others did. Let me know how it goes and do try to take it easy. I'll follow Jim's advice too.
    Take care
    Hope you're having a good day.

  • dilaurodilauro ConnecticutPosts: 9,865
    Some doctors will provide some form of mild sedation, while others do not.
    I have had it both ways. Even when it was the same Pain Management Center, but two different doctors.
    Honestly, it really didnt matter much to me, but that was because I was also on Oxycontin during those ESIs, so my judgment on sedation vs non-sedation would be somewhat cloudy.
    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
  • sunny1966ssunny1966 VIRGINIAPosts: 1,385
    I don't have any pain meds right now other than muscle relaxers and a few hydrocodone. That's what worries me. Is it fairly common to have even more pain for a few days after these injections? I know when I had an injection like this in my foot it was much more painful for the first three or four days after and then nothing. All my PCP will give me is muscle relaxers and tramadol. The last time he refilled my tramadol he said that I need to get off of it. I don't understand why no one wants to give me anything for pain. I didn't ask the nurse at PM about my prescriptions because I knew if I did they'd think I only want drugs. What am I supposed to do? My mri's plainly show what I'd call a just cause for me to need something stronger than Tramadol. At least I think so. Ah, I guess they think I should be able to handle it who knows? I wish I could!
    Hope you're as well as can be Ron.
  • dilaurodilauro ConnecticutPosts: 9,865
    See if your doctor can prescribe a small amount of a pain medication that works for you.

    Yes, you can experience some pain and discomfort the first 48-72 hours after the ESI.

    When I had any of my Steroid injections for my shoulder, the Orthopedic doctor gave me a script for 10 pills of vicodaine (not a high dosage). He did that even knowing I am on Opana daily. There is a difference in the way our body handles acute pain vs chronic pain.

    Wishing you the best
    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
  • Reading all your posts about your ESI's. I, too, am trying to prolong having surgery. My ortho surgeon scheduled me for 3 ESIs, always on Fridays and always with twilight sleep (Versed, I believe) and always in an operating room. The nurses told me he always insists on the twilight sleep. Fine with me because I was a huge chicken. It was done in the OR by the surgeon, 2 nurses present as well as the guy who runs the flouroscopy machine. They told me I'd need someone to take me home and stay with me for 8 hours OR ELSE I'd have to stay at the hospital for 8 hours. He told me to go home and do nothing for 24-48 hours. With the first one Oct. 9, the next day I felt about the same as before it. The second was Oct. 23rd and helped "somewhat". The third was Oct 30th and was done in a different spot. Other than the spot of injection hurting a little, it has helped the most. I am being careful with what I do but my pain is probably now about a 2, down from what I was used to - a 4 - 5. Something was definitely different with that last injection. It worked better or was in a better spot or something. I'm told if I need them I can have them again after March. At this point I won;t need them yet. If I am hurting a Motrin 600 takes care of it.

    All three times my sister checked me out of the hospital and drove me around to my car and I took myself home - alone. Twice I was fine. The third time I stopped at McDonalds like I had planned. HOWEVER, the next day I found a receipt for the grocery store where I had bought a ribeye steak and a gallon of milk! Don't remember doing that, nor do I remember the actual drive home. I don't even buy milk except for cooking, but the steak was delish lol! My sister says if I have more ESIs I am NOT being allowed to leave alone!
  • I had the twilight type too--you are under,but not really--for the ESIs I have had.I have had 2 coccyx injections right in the Dr.office with no sedation.It hurt,but it was worth it to make that pain go away!
  • Good for your sister! She is looking out for you and any other drivers on the road. Glad you have her watching your back... pun intended!

    When I was taking Ambien CR, I could only take it when I had adult supervision. If Mike (my hubby) was out-of-town on business, I had to take Tylenol PM. I would do things and not remember them... just as you shared above. Glad you enjoyed your steak... lol! :)

    I am so happy to hear that the injections have brought your pain down. So nice to hear.

    Thanks for sharing. :)


  • Thanks for sharing about the coccyx shots and relief!

    Debbie might need these, also, once she gets her neck taken care of.

    So happy to hear they have helped you. :)

    Take good care,


  • LOL, I also do things and don't remember them when I take Ambien!

    Regarding the OP- I've had 2 so far with no sedation, but I believe they give sedation on request. Today's was more uncomfortable than the last one. I am usually not the type to need sedation or pretreatment for anything.
  • I was scared when I had my first ESI AND IF YOUR PM numbs you good it really is not bad at all, the only concern I would have is not having anything for pain because the eve of you shot it takes time for the steroids to crystalize and increases the pain for a couple of days, get your ice pack ready and rest the evening of your shot ..I had myself terrified and I have a good pm doc he numbs really well and I was like what was I so scare for, my blood pressure was way high and I also talked to people on here that was really comforting..
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