Reactions 1471, p14 - 28 Sep 2013

SBupivacaine/fentanyl

Horner’s syndrome: case reportA 29-year-old woman developed Horner’s syndrome during

treatment with bupivacaine and fentanyl for epiduralanaesthesia.

The woman, who was 41 weeks pregnant, was undergoinginduced labour for post-maturity. Following prostaglandininduction and prior to receiving oxytocin [Syntocinon], sherequested epidural anaesthesia. She received 1mL ofbupivacaine 0.25% and 15g of fentanyl by injection through anepidural catheter. She received two top-ups of 0.1%bupivacaine 15mL with fentanyl 2 g/mL. However her painpersisted, so she received another top-op of bupivacaine0.25%. Drooping of the right eyelid was observed 6.5 hoursfollowing epidural administration. Upon examination, she hadright-sided ptosis and miosis. In addition, her right cheek wasdry and flushed. Of note, the signs were most noticeable afterepidural top-ups and resolved as the anaesthetic levelsdecreased.

The woman did not need further analgesia. She gave birth toa healthy baby boy. In the ensuing hours, the Horner’ssyndrome resolved.

Author comment: "Epidural anaesthesia is commonlyused in obstetrics and Horner’s syndrome has been observedas a rare complication."Sharma R, et al. Horner's syndrome with epidural anaesthesia. BMJ CaseReports 2010: [3 pages], 24 Aug 2010. Available from: URL: http://dx.doi.org/10.1136/bcr.01.2010.2698 - United Kingdom 803093258

1

Reactions 28 Sep 2013 No. 14710114-9954/13/1471-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved