剖腹產後自控式術後止痛和腰椎麻醉所引起之壓迫性褥瘡

Large Sacral Pressure Ulcer Following Cesarean Section under Spinal Anesthesia and Post-Operative Patient-Controlled Analgesia--A Case Report

破腹產後自控式術後止痛之副作用很多、包括嗜睡、想吐、小便困難、皮膚發癢及呼吸困難，但引發壓迫性褥瘡之病何未曾報告過。本文報告一位病患於腰椎麻醉後執行破腹產手術，並使用自控式術後止痛法來控制傷口痛。該病患產生了尾薦處之潰爛。本文探討其產生原因、機轉、及其預防方法。

Spinal anesthesia and patient-controlled analgesia (PCA) are common practice for cesarean section. Side effects from these procedures include neurological damage or prolonged block from spinal anesthesia and sedation, nausea, vomiting, skin itcbing, urinary retention and respiratory depression from PCA. It has not been reported before, however, that a decubitus ulcer could develop postoperatively which required intervention with plastic surgery. We herein reported the occurrence of a decubitus ulcer developed over the sacrococcygeal area in a patient who was under spinal anesthesia for cesarean section, used PCA with morphine for postoperative pain control and had self-imposed immobilization for the first postoperative day. The pressure ulcer worsen despite the conservative treatment for 4 weeks and eventually necessitated a debridement followed 1 week later by a double V-V flap performed under general anesthesia. This case demonstrated that such a complication could occur in a young healthy patient. Contributing factors the development of non-healing pressure ulcer following spinal anesthesia for cesarean section, such as postoperative immobilization and the use of PCA are discussed. Based on our observation, it is recommended that the medical staffs should be alert to the possibility of decubitus ulcer developing in patient in similar conditions as we described in this report, It is suggested that early institution of appropriate measures and increased attention to the skin condition may prevent this complication.