Pressure sores as a complication of patient-controlled epidural analgesia after cesarean delivery. Case report.

BACKGROUND AND OBJECTIVES: 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.

Postpartum headache, seizures and bloodstained C.S.F.: a possible complication of dural puncture?

A 32-year-old parturient developed severe headache with subsequent convulsions on the third day after the delivery under epidural anesthesia. Neuroradiological investigations were negative. All complaints disappeared promptly after the performance of an epidural blood patch.