Reactions 1271 - 26 Sep 2009

Bupivacaine

Horner’s syndrome following extrapleuralinfusion: case report

A 58-year-old woman developed Horner’s syndromefollowing extrapleural infusion of bupivacaine forpostoperative pain following thoracotomy.

Following the discovery of a right upper lobe pulmonarymass, the woman was admitted for a right upper lobewedge resection. She was placed under generalanaesthesia and underwent right fifth intercostalposterolateral thoracotomy. A completion lobectomy wasperformed after intraoperative confirmation of a non-smallcell adenocarcinoma. Before thoracotomy closure, an On-Q system, which contained 450mL of 0.25% bupivacainewas introduced extrapleurally with a 20-gauge soaker-hosecatheter. Following confirmation of correct placement,bupivacaine was infused at 3 mL/h. She underwent woundclosure with placement of two chest tubes, anteriorly andposteriorly. On postoperative day 1, she reported righteyelid heaviness. Right-sided blepharoptosis and pupillarymiosis was noted. In addition, she reported symptomsconsistent with ipsilateral facial anhidrosis. She wasdiagnosed with acute unilateral Horner’s syndrome.

The woman underwent prompt removal of herextrapleural catheter and, by the next day, her Horner’ssyndrome had completely resolved. She did not experienceany other complications related to her extrapleural catheterduring her admission.Blechman KM, et al. Post-thoracotomy Horner syndrome associated withextrapleural infusion of local anesthetic. Interactive Cardiovascular and ThoracicSurgery 9: 309-310, No. 2, Aug 2009 - USA 801150818

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Reactions 26 Sep 2009 No. 12710114-9954/10/1271-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved