Continuous epidural analgesia for postoperative pain relief can mask critical warning signs of severe complications like stress gastric ulcers, resulting in delayed diagnosis and life-threatening hemorrhage.
Continuous epidural analgesia is getting common for post operative pain relief. However, postoperative suppression of pain can hide painful pathological responses that will alart abnormallities in the body. A 71-year-old man, 48kg in wight, 158cm in height had a cancer of the sigmoid colon and a right inguinal hernia and underwent a resection of the sigmoid colon and a right herniorrhaphy. He had massive hematemesis and bloody stool on the 7th postoperative day that required a gastrectomy. Anesthesia for the first operation was general anesthesia combined with thoracic epidural analgesia and he had been treated post operative analgesia through this epidural catheter by using infuser (Baxter infusion pump, 1.0ml/h, for 5 days), which contained 0.125% bupivacaine 60ml and 10mg of morphine. Postoperative analgesia was perfect and the patient did not have any discomforts at all. This situation led to mask stress gastric ulcer until massive hemorrhage occurred on the 7th postoperative day.
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Yokoyama et al. (1999) studied this question.
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