Reactions 1323 - 16 Oct 2010

Bupivacaine/fentanyl/ropivacaine

Horner’s syndrome following epiduraladministration: case report

A 23-year-old woman developed unilateral Horner’ssyndrome following epidural analgesia during labour andcaesarean section.

The woman requested epidural analgesia during labourand was injected with 0.1% ropivacaine 20mL and fentanyl50µg in incremental doses; her epidural catheter was sitedin her L3/4 interspace. Adequate pain relief was achieved andsensory block at T8 level on both sides was confirmed. Shestarted continuous epidural infusion 0.1% ropivacaine withfentanyl 2 µg/mL at 12 mL/hour. She required two epiduraltop-ups for break-through pain over the next 6 hours, andwas injected each time with 0.1% ropivacaine 12mL. Dueto non-progress of labour and concerningcardiotocography, caesarean section was performed. Shereceived an epidural top-up of 0.5% bupivacaine 20mL withfentanyl 100µg in incremental doses and Ringer’s lactate inthe operating theatre. After 15 minutes, the level of blockwas at T6. The baby was born without incident and hercourse of anaesthesia was unremarkable. However, thefollowing day she reported heaviness in her left eye andnumbness over her left side of her face. Investigationsrevealed ptosis of her left eye, dryness, miosis and flushingof the left side of her face. She was diagnosed with left-sided Horner’s syndrome.

On reflection, the woman’s partner revealed that shortlyafter the epidural was sited, her left eye looked smaller, butat the time, dismissed it. No additional intervention wasrequired and almost 44 hours after the epidural block, allher symptoms had completely resolved.Sinha N, et al. A case of unilateral Horner’s syndrome diagnosed in retrospectfollowing epidural analgesia during labour and caesarean section. Middle EastJournal of Anesthesiology 20: 753-4, No. 5, Jun 2010 - United ArabEmirates 803041631

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Reactions 16 Oct 2010 No. 13230114-9954/10/1323-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved