title: Pressure sores as a complication of patient-controlled epidural analgesia after cesarean delivery. Case report.
abstract: OBJECTIVE
  Postoperative epidural analgesia using mixtures of bupivacaine and opioids has become common practice following abdominal surgery. Side effects such as hypotension, motor block, respiratory depression, pruritus, and urinary retention are well known. Pressure sores occurring within the first 24 hours are extremely rare.
  
  
  METHODS
  Three parturients scheduled for cesarean delivery received for postoperative pain relief with a patient-controlled epidural analgesia, consisting of 0.11% bupivacaine, 2 micrograms/mL sufentanil, 3 micrograms/mL clonidine, and 1.25 micrograms/mL epinephrine.
  
  
  RESULTS
  Within the first postoperative day pressure sores were observed at one heel. In one patient the coccygeal area was also affected. After discontinuation of the patient-controlled analgesia and local treatment, including application of heel pads, the pressure sores healed uneventfully.
  
  
  CONCLUSIONS
  Pressure sores following postoperative epidural analgesia may occur even in young patients. Although bupivacaine may induce a motor block, its combination with other drugs in the analgesic mixture or other contributing factors may explain the occurrence of pressure sores. Prophylaxis and increased alertness should eliminate this complication.
authors.affiliation: Department of Anesthesiology, Sint Jansziekenhuis, Schiepse-Bos Genk, Belgium.
authors.forename: I G
authors.initials: IG
authors.lastname: Smet
authors.forename: M P
authors.initials: MP
authors.lastname: Vercauteren
authors.forename: R F
authors.initials: RF
authors.lastname: De Jongh
authors.forename: G J
authors.initials: GJ
authors.lastname: Vundelinckx
authors.forename: R J
authors.initials: RJ
authors.lastname: Heylen
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D016362:Analgesia, Obstetrical / Q000009:adverse effects*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011247:Pregnancy; D003668:Pressure Ulcer / Q000209:etiology*