Reactions 1253 - 23 May 2009

Ropivacaine

Horner’s syndrome following epiduraladministration in a pregnant woman: case report

A 32-year-old pregnant woman developed Horner’ssyndrome while receiving epidural anaesthesia withropivacaine during labour.

The woman was hospitalised at 38 weeks of gestationand underwent placement of an epidural catheter at L3/4level; the epidural space was located after three punctures.While lying on her side, she then began receiving acontinuous infusion of 0.15% ropivacaine at a rate of10 mL/h. She developed reduced vision in her left eye and‘withering’ of her left arm 30 minutes later. Neurologicalexamination showed miosis, palpebral ptosis andenophthalmos, compatible with Horner’s syndrome, andassociated anhydrosis of the affected side of her face. Heranaesthesia level was D3 on her right, and C6 on her leftside.

The woman was placed supine, and the ropivacaineinfusion rate was decreased to 5 mL/h. Within 2 hours,Horner’s syndrome and dysaesthesia of her arm resolved.She gave birth to a healthy boy 1 hour later.

Author comment: It is believed that Horner’s syndromeassociated with anaesthesia is caused by blockade of thesympathetic fibres of the stellate ganglion. This complicationis more common in pregnant women because of theengorgement of the epidural veins which is enhanced byuterine contractions.Jimenez-Caballero PE. Horner’s syndrome following epidural analgesia. Revista deNeurologia 48: 54-55, No. 1, Jan 2009 [Spanish; summarised from a translation.] -Spain 801126797

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Reactions 23 May 2009 No. 12530114-9954/10/1253-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved