Reactions 1262 - 25 Jul 2009

SBupivacaine/fentanyl

Hypoglossal nerve palsy, trigeminal nerve palsyand Horner’s syndrome following epidural block:case report

A 34-year-old woman experienced hypoglossal nervepalsy, trigeminal nerve palsy and Horner’s syndromefollowing epidural block with bupivacaine and fentanyl[time to reaction onset not clearly stated].

The woman presented at 38 weeks’ gestation after hermembranes had spontaneously ruptured. During the firststage of labour, she received an oxytocin infusion andrequested epidural analgesia. An epidural catheter wasplaced in the L2-3 interspace and she received a test dose ofbupivacaine [dosage not stated] with no signs of intrathecalor intravascular placement. She then received 12mL of0.1% bupivacaine with fentanyl 2 µg/mL, followed by acontinuous infusion of the same solution (12 mL/hour). Theepidural worked effectively for 22 hours. However, herlabour failed to progress and the decision was made toproceed with a caesarean section. She received anadditional 18mL of 0.5% bupivacaine with fentanyl 100µg.Towards the end of the surgery, 55 minutes after theepidural top-up, she reported nasal congestion, nausea anddifficulty breathing.

The woman received supplemental oxygen and remainedcomfortable throughout the surgery. After the procedure,her epidural catheter was removed and she was transferredto the postnatal ward. Five hours later on review, she hadleft-sided Horner’s syndrome with marked ptosis andmiosis. She had decreased motor power, tone andsensation in her left arm compared with her right. She alsohad decreased motor power on elevation of her leftshoulder. Cranial nerve examination revealed decreasedsensation over her face in the distribution of her maxillaryand mandibular divisions of her trigeminal nerve. Hertongue, when protruded, had a marked deviation to theright and she could not move it towards the left. The nextday, she felt better and her neurological symptoms hadresolved.Rowley C, et al. Hypoglossal nerve palsy, trigeminal nerve palsy and Horner’ssyndrome in association with epidural block. International Journal of ObstetricAnesthesia 18: 191-192, No. 2, Apr 2009 - United Kingdom 801146718

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Reactions 25 Jul 2009 No. 12620114-9954/10/1262-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved