Epidural steroid injections are clearly superior to local anesthetics alone. The injections are most effective when given within 2 weeks of the onset of pain but appear to be of little benefit in the absence of neural compression or irritation. Long-term studies have failed to show any persistent benefit after 3 months. The steroids may be injected with diluent (saline) or local anesthetics in volume of 6-10 mL or 102-mL of lumbar and caudal injections, respectively. The Epidural Needle should be cleared of the steroids prior to its withdrawal to prevent formation of a fistula tract. The local anesthetics provides immediate pain relief until the steroids anti inflammatory effects takes place, usually within 24-48 hours.

Epidural steroids injections may be most effective when the injection is at the site of injury. Only a single injection is given if complete pain relief is achieved. If there is no initial response, a second injection may be given 2-4 weeks later. Many pain practitioners utilize fluoroscopy for epidural injection and confirm correct placement with radiocontrast. A transforaminal epidural steroid injection (selective nerve root block) is reported to be more effective than the standard translaminar epidural technique. The Epidural Needle is directed under fluoroscopic guidance into the foramen of the affected nerve root and contrast is injected to confirm entry into the epidural space prior to steroid injection.