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B399 Persistent Horner’s syndrome following lower cervical ganglion block under ultrasound guidance
  1. P Dhillon and
  2. V Archontaki
  1. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK


Background and Aims Horner’s Syndrome is a possible side effect following lower cervical ganglion block which may last up to 8–12 hours (1). We describe a case where lower cervical ganglion block was performed to alleviate sympathetically maintained pain of the right wrist (1,2). In this case, the Horner’s syndrome lasted for 16 days before it subsided completely.

Methods A 21 years old woman with diagnosis of sympathetically maintained pain of her wrist, underwent lower sympathetic ganglion block under ultrasound guidance as a day case procedure without sedation. A total amount of dexamethasone 6,6 mg (2 ml) and L-Bupivacaine 0,25% (3 ml) were injected via in plane approach after negative aspiration.The procedure was uneventful and no pain or paresthesia were reported during the block. Horner’s syndrome was observed 8 min later.Vital signs remained within normal limits until her discharge after 2 hours.

Results On 6thday the patient reported signs and symptoms of persistent Horner’s syndrome along with generalised symptoms of fatigue and dizziness which subsided completely on 16th day. Although slight blurred vision persisted, she was prescribed glasses for underlying astigmatism by the opthalmologist recently. She was noticed significant improvement in pain and hand function.

Conclusions There was not an obvious cause to provoke any kind of injury on the sympathetic fibres. Possible causes could be the microtrauma/ischemia from the needle tip(3), the high injection pressure and the toxicity from local anaesthetic(4,5). However, the Horner’s syndrome subsided spontaneously after 16 days and no other intervention was necessary.

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