Reactions 1200 - 3 May 2008

Bupivacaine/fentanyl

Horner’s syndrome following epiduraladministration: case report

A 29-year-old pregnant woman developed a transient right-sided Horner’s syndrome, after receiving bupivacaine andfentanyl as epidural anaesthesia during a Caesarean section.

After fetal distress developed at 39 weeks’ gestation, thewoman underwent an emergency Caesarean section. She wasadministered bupivacaine and fentanyl [dosages not stated] inthe first stage of labour; the drugs were then topped up prior tothe procedure. During the procedure, within 30 minutes of theepidural top up, her right pupil was observed to be smaller andthe eyelid was drooping [time to reaction onset not stated].Over the next few minutes it got worse. Ninety minutes afterthe onset of the Horner’s syndrome, a neurologicalexamination confirmed meiosis and blepharoptosis. MRI,magnetic resonance angiography scans and echocardiographydid not reveal any other new abnormalities. She was diagnosedwith transient Horner’s syndrome, secondary to lumbarepidural anaesthesia.

The Horner’s syndrome persisted for 3 hours, and resolvedwhen the epidural was ceased.

Author comment: "Horner’s syndrome after epiduralanalgesia is thought to be due to upwards spread of theanaesthetic within the epidural space affecting the secondorder neurones as they exit the cord."Rohrer JD, et al. Transient Horner’s syndrome during lumbar epidural anaesthesia.European Journal of Neurology 15: 530-531, No. 5, May 2008 -England 801080687

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Reactions 3 May 2008 No. 12000114-9954/10/1200-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved