Clinical Review Lesson of the week

Postoperative pressure sores after epidural anaesthesia

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7266.941 (Published 14 October 2000) Cite this as: BMJ 2000;321:941
  1. J L Shah, consultant ([email protected])
  1. Department of Anaesthetics, City Hospital, Birmingham B18 7QH
  1. Correspondence to: J L Shah, Department of Anaesthetics, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH
  • Accepted 21 January 2000

Pressure sores may occur when epidural analgesia produces profound sensory and motor block

Epidural anaesthesia and analgesia provide a better outcome after major surgery.1 Side effects of epidural such as dural puncture, motor block, and hypotension are well known. Epidural analgesia may also cause pressure sores in elderly and debilitated patients.2 The general belief is that pressure sores do not occur in patients who are fit and mobile. This report describes three cases of heel ulcers in fit young patients related to pressure after epidural analgesia. None of the patients had any predisposition to pressure related ulceration. In two of the patients the heel ulcers became apparent several days after surgery.

Case reports

Case 1—A 52 year old woman weighing 42 kg had carcinoma of the vulva. She was otherwise fit and active. She smoked 20 cigarettes a day. She had a radical vulvectomy and bilateral inguinal lymphadenectomy under combined general and epidural anaesthesia. She was given 20 ml of 0.25% bupivacaine for epidural anaesthesia. To prevent pressure sores, the operating table was covered with silicon jelly pads. Surgery lasted about three hours. The patient was supine for the first 90 minutes and in the lithotomy position thereafter. Her preoperative blood pressure was 120/70 mm Hg. During surgery her systolic blood pressure varied between 85 and 90 mm Hg and her general condition was stable. She received a continuous epidural infusion of plain 0.15% bupivacaine for postoperative analgesia. She remained free of pain and was comfortable. Her systolic blood pressure varied between 75 and 85 mm Hg. She was unable …

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