Reactions 1182 - 15 Dec 2007

Bupivacaine/fentanyl

Harlequin syndrome and Horner’s syndromefollowing intrathecal administration: case report

A 47-year-old woman with breast cancer underwentthoracic epidural anaesthesia (TEA) for modified radicalmastectomy. A total of 0.5% bupivacaine 10mL was injectedinto the epidural space at T2/3 level, as divided doses in5-minute intervals. After surgery, she received patient-controlled analgesia (PCA) with a mixture of 0.05%bupivacaine and 0.5% fentanyl at a bolus dose of 0.1 mL/kg;the infusion rate was 0.13mL-kg-1h-1 [sic] and the lockouttime was 15 minutes. After 3 hours, she was noted to exhibitright hemifacial flushing and diaphoresis, and left-sidedHorner’s syndrome. The PCA was discontinued. Facial flushingsubsided within 6 hours and Horner’s syndrome resolved after12 hours.

Author comment: "Even though TEA has been reported tobe a safe anesthetic technique for [modified radicalmastectomy], high levels of thoracic anesthesia may causethis syndrome."Aydin T, et al. Transient coexisting horner and harlequin syndromes after thoracicepidural anesthesia for modified radical mastectomy. Regional Anesthesia and PainMedicine 32 (Spec. issue 1): 46 abstr. 291, No. 5, Sep-Oct 2007 [abstract] -Turkey 801095020

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Reactions 15 Dec 2007 No. 11820114-9954/10/1182-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved