Reactions 1135 - 20 Jan 2007

Bupivacaine/fentanyl

Horner’s syndrome in infants following epiduraladministration: 2 case reports

Two infants, who were scheduled to undergo surgery forcongenital cystic adenomatoid malformation, developedHorner’s syndrome during epidural anaesthesia withbupivacaine and fentanyl.

A 17-month-old boy received 5mL of 0.25% bupivacainewith epinephrine [adrenaline] followed by 0.1% bupivacaineand fentanyl 2 µg/mL at 2.5 mL/h. Following surgery, hisepidural infusion was increased to 3 mL/hour. He developedpruritus for which he received naloxone. Seventeen hours aftersurgery, he had right upper limb weakness. The epiduralinfusion was reduced to 2.5 mL/h. Within 4 hours, his rightupper limb motor function recovered. Approximately 24 hoursafter surgery, right blepharoptosis, conjunctival congestion,miosis and swelling were observed. The epidural infusion wascontinued for a total of 68 hours. His right eye normalised1 hour after the epidural infusion was stopped. The epiduralcatheter was removed and he was discharged on his fourthpostoperative day with no sequelae.

A 12-week-old girl received 2mL of 0.25% bupivacaine withepinephrine followed by a continuous infusion of 0.1%bupivacaine and fentanyl 2 µg/mLat 0.7mL/h. Twenty-sevenhours after surgery, right-sided blepharoptosis and miosiswere observed. The epidural infusion was continued for a totalof 46 hours. After the infusion was discontinued, her ocularsigns recovered and she was discharged the same day asremoval of her epidural catheter.Valois T, et al. Horner’s syndrome following thoracic epidural analgesia inchildren: a report of two cases. Acute Pain: International Journal of Acute PainManagement 8: 83-86, No. 2, Jun 2006 - Canada 801060138

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Reactions 20 Jan 2007 No. 11350114-9954/10/1135-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved