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Rapid response to:

Clinical Review Lesson of the week

Postoperative pressure sores after epidural anaesthesia

BMJ 2000; 321 doi: (Published 14 October 2000) Cite this as: BMJ 2000;321:941

Rapid Response:

Postoperative pressure sores after epidural anaesthesia.

Editor - I read with interest the recent lesson of the week by Dr
Shah (1), regarding pressure sores and epidural anaesthesia. I agree with
Dr Shah's comments regarding the prevention of pressure sores, namely,
that heel pads
should be worn routinely, recovery should take place on a ripple type
mattress, hypotension should be avoided, patients with motor block should
be treated as paraplegic patients and turned regularly, and motor and
block should be avoided in legs by using lower thoracic instead of lumbar
epidural blocks.

However, Dr Shah has omitted two further methods of reducing motor block
and thereby pressure sores. Namely, the addition of a low dose opiate
(e.g. fentanyl or diamorphine) into the epidural infusion allows a lower
concentration of local anaesthetic to be used resulting in less profound
motor block. I note that only one of his case reports had an opiate in her
epidural infusion, with her pressure sore being the least severe.

regular supplementary analgesia with paracetamol and diclofenac produces
pain control, allowing the epidural infusion to be run at a lower rate or
with a reduced concentration of local anaesthetic, again resulting in a
less profound motor block. These recommendations in addition to Dr Shah's
suggestions will hopefully make postoperative pressure sores after
epidural anaesthesia a thing of the past.

Kevin D Rooney

Specialist Registrar in Anaesthesia

South Glasgow University Hospitals NHS Trust,
Southern General Hospital,
1345 Govan Rd,
Glasgow G51 4TF,
Scotland, UK.

1. Shah J L. Postoperative pressure sores after epidural anaesthesia.
BMJ 2000; 321: 941-2

Competing interests: No competing interests

28 October 2000
Kevin D Rooney