Before the injection procedure begins, topical anesthesia is applied to the skin. Next, in order to prevent healthy nerve roots from being exposed to too much medication, the physician will use imaging technology such as fluoroscopy to guide the insertion of the needle and to confirm its correct placement in the epidural space. In addition, contrast dye is typically injected in order to observe where the medication will be administered and to ensure that it will be properly distributed throughout the targets areas. The administration of steroids and an anesthetic such as Lidocaine directly onto the nerves roots results in dramatic or complete pain relief. The steroid decreases inflammation, while the anesthetic disrupts pain signal transmission.
Kenalog in blood - Derby et al. "Size and aggregation of corticosteroids used for epidural injections"
When the disease is in its chronic form -as it usually happens after spine surgery or following the acute and subacute phase of radiculitis from disc herniation that had been undertreated with conservative therapy- neuroplasty (adhesiolysis) with Racz catheter is indicated.
The American Society of Interventional Pain Physicians (ASIPP) published evidence-based guidelines for invasive techniques in the management of chronic spinal pain.
According to these guidelines, there is strong evidence indicating the efficacy of neuroplasty with corticosteroids in the short and long-term control of pain in refractory radiculopathy and neuropathic spinal pain.