Reactions 968 - 13 Sep 2003

Bupivacaine

Horner’s syndrome: case reportA 32-year-old woman developed Horner’s syndrome during

labour while receiving epidural bupivacaine.The woman was in active spontaneous labour when an

epidural catheter was inserted at the L3-L4 interspace. Theposition of the catheter was confirmed by a negative aspirationtest and she received 3mL and then 2mL of 1.5% lidocaine withepinephrine and was placed in a left lateral decubitus position.She received a total of 15mL of a solution comprising 0.04%bupivacaine with fentanyl 1.66 µg/mL given in 5 mLincrements every 5 minutes and an infusion of the samesolution was started at 15 mL/h. Approximately 1 hour latershe reported heaviness of her left eye. She had miosis,conjunctival injection and blepharoptosis of the left eye, andthere was decreased sensation to cold in the ulnar border ofher left arm. There was mild motor weakness in both her lowerextremities but normal symmetrical strength in all the musclegroups in her upper extremities; left-sided Horner’s syndromedue to exaggerated cephalad spread of local anaesthetic in theepidural space was suspected.

The epidural infusion was stopped and the woman wasplaced in the right lateral decubitus position; the infusion wasrestarted 1 hour later at a rate of 12 mL/h. Signs of Horner’ssyndrome resolved within 2 hours and the infusion wascontinued at 15 mL/h with no recurrence of Horner’ssyndrome.Chandrasekhar S, et al. Horner’s syndrome following very low concentrationbupivacaine infusion for labor epidural analgesia. Journal of Clinical Anesthesia15: 217-219, No. 3, May 2003 - USA 807214155

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Reactions 13 Sep 2003 No. 9680114-9954/10/0968-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved