Background and Aims Subdural blockade is a rare complication after neuraxial anesthesia, which usually manifests as a patchy or disproportionate block.
We present a case of a primiparous that developed unilateral upper arm sensory and motor blockade associated with ipsilateral Horner’s syndrome after epidural anesthesia for urgent cesarean-section.
Methods An obese primiparous, 23-years-old, 39 weeks and 4 days pregnant, ASA II, was admitted in latent phase of labour. After 12 hours, an epidural catheter was inserted (L3-L4 level) and 10 mL of ropivacaine 0.2% and 10mcg of sufentanil were injected with pain relief. Epidural analgesia was administered as requested with no complications during labour.
Results After 24h, an urgent cesarean-section was performed due to stationary labour. After injection of 12 mL of ropivacaine 0.75% through the epidural catheter, a fall superior to 20% of basal blood pressure was noted, with need for vasoactive drugs, associated with upper arm motor and sensitive blockade. After neurologic examination, ipsilateral Horner’s syndrome was detected. High regional block was excluded. A newborn was delivered with APGAR score of 9–9-10. At the post anesthesia care unit, possible subdural drug spread was assumed, and the catheter removed. Two hours later, upper arm motor and sensitive blockade was reversed, with ptosis and miosis maintenance. The patient was discharged to the nursery.
After 12 hours, ptosis and miosis were solved. Discharge home occurred on the second postoperative day.
Conclusions New neurologic manifestations after epidural drug administration require brief evaluation to exclude complications as high regional block.
Effective communication with the patient is of utmost importance.