Most people find it uncomfortable rather than painful, and the procedure itself takes about fifteen minutes. The parts that hurt are brief and predictable, and knowing the sequence is most of what makes it manageable.
What actually happens, in order
- Positioning. You lie face down, usually with a pillow under the abdomen to open the spaces between the vertebrae. For some people this position is itself the least comfortable part.
- Skin cleaning. Cold antiseptic. Sterile technique here is what prevents infection, so it is thorough.
- Local anaesthetic. A small sting and a burning sensation lasting a few seconds as the skin and deeper tissue are numbed. This is the sharpest moment of the whole procedure.
- The needle. Pressure rather than sharpness. Deeper injections need more local anaesthetic first, and where the epidural space sits deeper the clinician will say so and numb further.
- Contrast and imaging. No sensation. The X-ray confirms position before anything is delivered.
- The medication. A feeling of pressure or fullness, occasionally a brief reproduction of your usual leg pain as fluid enters the space. That is expected and settles within seconds.
How long it takes
The injection itself is roughly ten to fifteen minutes. Expect to be at the clinic for an hour to ninety minutes including consent, positioning, the procedure and a short observation period.
Why the local anaesthetic step matters so much
The comfort of the whole procedure rests on this step being done properly rather than quickly.
In a recorded teaching case, Dr. María Alejandra De La Peña works with a patient whose epidural space sits deeper than usual. Her instruction to the trainee is simply to give more anaesthesia — “you proceed to give more anesthesia, since this is a deeper block” — before advancing further.
If you feel sharpness rather than pressure once the procedure is underway, say so. More local anaesthetic can be given. Sharp pain during needle advancement is information the clinician wants.
Will you be sedated?
Usually not. Most lumbar epidural injections are performed with local anaesthetic alone, and there are good reasons for that: you remain able to report what you feel, and you can leave without a recovery period or someone to drive you.
Sedation is offered for significant anxiety, for difficult anatomy, or for longer procedures. If you have it, you will need a driver and should not work for the rest of the day.
Feeling faint is common, and is not the drug
Worth saying plainly because it surprises people, and it disproportionately affects those who expect to cope best.
De La Peña describes vasovagal syncope as “very common, especially in strong young patients” — and attributes it to nerves: “they get nervous, so they get like a syncopal episode with low blood pressure.” Her management is straightforward: lie the patient supine, bend the knees, give fluids, and reassure them.
Tell the team if you have fainted during blood draws or procedures before. It changes nothing about whether you can have the injection, and it lets them position you accordingly.
What it feels like afterwards
Expect soreness at the site for a day or two, and possibly a temporary increase in your usual pain as the local anaesthetic wears off. Faculty treat this post-procedure pain as an expected event managed with reassurance, ice, NSAIDs or a muscle relaxant — not as a failed injection.
A leg may feel heavy or slightly numb for a few hours from the local anaesthetic. That resolves.
What to do and avoid in the following days is covered in what not to do after an epidural steroid injection.
If you are anxious about it
- Say so. Anxiety is the main driver of the fainting described above, and a team that knows will manage the room differently.
- Eat beforehand unless you have been told otherwise. An empty stomach makes a vasovagal episode more likely.
- Ask to be talked through each step as it happens. Knowing that pressure is coming changes how pressure feels.
- Bring someone, even if sedation is not planned.
- Ask about the numbing specifically. It is the step that determines your experience of everything after it.
Is it worse than what you already have?
For most patients the honest comparison is that fifteen minutes of pressure and a few seconds of stinging is a smaller experience than the pain that brought them in.
The procedure is not pleasant, but it is short, it is over when you leave, and nothing about it lasts beyond a couple of days of soreness.
Learn blocks with your hands, not from a page
Empire’s Pain Management Training (THE Pain Show) is accredited for 25.25 AMA PRA Category 1 Credits™, jointly provided by AKH, Inc, and Empire Medical Training. For narrower peripheral work, Joint, Extremity and Non-Spinal Injection Training carries 6.75 credits for the complete in-person hybrid program, and Advanced Musculoskeletal Ultrasound Guided Injections builds the guidance skills above.
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