Pressure Ulcers After Epidural Anaesthesia

  • Agata Janowska
  • Valentina Dini
  • Marilena Pradal
  • Giulia Davini
  • Francesco Uccelli


Control of pain with epidural anaesthesia represents a major advance in the care of delivery and it is a part of standard gynecologic surgery. Side effects of this procedure are motor block, hypotension, rarely lower limb paralysis, hypothermia, and vertebral canal haematomas. A prolonged anaesthetic effect can be a primary risk factor of pressure ulcers development in healthy women.

Managing risk is a fundamental part of clinical practice and it is essential that equipment used is appropriate to the situation. Developing a training and educational program specifically is relevant for all the female patients and hospital multidisciplinary team.

There is a real need for all hospital teams to implement guidelines on prevention, surveillance and to monitor activities during the delivery and during the standard gynecological surgical procedures.


  1. 1.
    Wiedermann FJ, Lingnau W, Innerhofer P. Postoperative pressure sores after epidural anaesthesia. Good nursing care should prevent pressure sores. BMJ. 2001;322(7288):732–3.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wildsmith JA. Postoperative pressure sores after epidural anaesthesia. Informed nursing care is needed. BMJ. 2001;322(7288):733.PubMedGoogle Scholar
  3. 3.
    Hughes C. Obstetric care. Is there risk of pressure damage after epidural anaesthesia? J Tissue Viability. 2001;11(2):56–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Shah JL. Lesson of the week: postoperative pressure sores after epidural anaesthesia. BMJ. 2000;321(7266):941–2.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Alfirevic A, Argalious M, Tetzlaff JE. Pressure sore as a complication of labor epidural analgesia. Anesth Analg. 2004;98(6):1783–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Naruse S, Uchizaki S, Mimura S, Taniguchi M, Akinaga C, Sato S. Pressure ulcer caused by long-term keeping of the same body position during epidural labour analgesia. Masui. 2016;65(6):643–5.PubMedGoogle Scholar
  7. 7.
    Takahashi E, Isonishi S, Suzuki M, Ogura A, Kunito S, Hirama M, Shoji H, Ochiai K, Tanaka T. Two cases of epidural anesthesia-associated postoperative decubitus. J Obstet Gynaecol Res. 2008;34(4 Pt 2):763–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Hoogendoorn I, Reenalda J, Koopman BFJM, Rietman JS. The effect of pressure and shear on tissue viability of human skin in relation to the development of pressure ulcers: a systematic review. J Tissue Viability. 2017;26(3):157–71.CrossRefPubMedGoogle Scholar
  9. 9.
    Stausberg J, Kiefer E. Classification of pressure ulcers: a systematic literature review. Stud Health Technol Inform. 2009;146:511–5.PubMedGoogle Scholar
  10. 10.
    Beeckman D, Schoonhoven L, Fletcher J, Furtado K, Gunningberg L, Heyman H, Lindholm C, Paquay L, Verdú J, Defloor T. EPUAP classification system for pressure ulcers: European reliability study. J Adv Nurs. 2007;60(6):682–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Offori EM, Popham P. Decubitus ulcers after instituting epidural analgesia for pain relief in labour. Anaesthesia. 2000;55(2):194.CrossRefPubMedGoogle Scholar
  12. 12.
    Jury CS. Postoperative pressure sores after epidural anaesthesia. Staff needs to recognise patients are at risk. BMJ. 2001;322(7288):733–4.PubMedGoogle Scholar
  13. 13.
    Aljezawi M, Al Qadire M, Tubaishat A. Pressure ulcers in long-term care: a point prevalence study in Jordan. Br J Nurs. 2014;23(6):S4. S6, S8, S10–1CrossRefPubMedGoogle Scholar
  14. 14.
    Valiani V, Chen Z, Lipori G, Pahor M, Sabbá C, Manini TM. Prognostic value of braden activity subscale for mobility status in hospitalized older adults. J Hosp Med. 2017;12(6):396–401.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Siman AG, Brito MJM. Changes in nursing practice to improve patient safety. Rev Gaucha Enferm. 2017;37(spe):e68271.PubMedGoogle Scholar
  16. 16.
    Ayello EA, Dowsett C, Schultz GS, Sibbald RG, Falanga V, Harding K, Romanelli M, Stacey M, TEot L, Vanscheidt W. TIME heals all wounds. Nursing. 2004;34(4):36–41. quiz, 41–2.CrossRefPubMedGoogle Scholar
  17. 17.
    Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, Romanelli M, Stacey MC, Teot L, Vanscheidt W. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11(Suppl 1):S1–28.CrossRefPubMedGoogle Scholar
  18. 18.
    Westby MJ, Dumville JC, Soares MO, Stubbs N, Norman G. Dressings and topical agents for treating pressure ulcers. Cochrane Database Syst Rev. 2017;6:1–201.Google Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Agata Janowska
    • 1
  • Valentina Dini
    • 1
  • Marilena Pradal
    • 1
  • Giulia Davini
    • 1
  • Francesco Uccelli
    • 1
  1. 1.Department of DermatologySanta Chiara Hospital, University of PisaPisaItaly

Personalised recommendations