Article Text
Abstract
Background and Aims Horner syndrome is a rare complication of epidural analgesia. Pregnancy may predispose to it, since epidural space may be narrower. This case report aims to present the management of Horner syndrome after combined-spinal epidural (CSE) labour analgesia.
Methods A 20-year-old primigravida (40w1d), presented to the emergency department with premature rupture of membranes. She was obese (BMI 32.5kg/m2) and asthmatic. A CSE was performed, at L3-L4 level. We used a 18G Tuohy needle and loss of resistance technique. A 27G Quincke needle was introduced through it. Once cerebrospinal fluid was obtained, we injected 2.5mg of hypobaric levobupivacaine 0.5% plus 2.5µg of sufentanil. Then, the epidural catheter was advanced cranially and fixed at a depth of 10cm in the skin (4.5cm length in the epidural space).
Results The patient remained painless for 2 hours. After negative aspiration and negative test dose, we injected 10mL 0.2% ropivacaine. 30 minutes after, the patient had left ptosis, miosis and conjunctival hyperemia. 30 minutes after, the symptoms resolved. 1h30min after, she needed further analgesia. We injected 5mL 0.2% ropivacaine and no symptoms developed but analgesia was not enough, so we injected more 5mL and she remained asymptomatic. 1h30min later, we injected 10mL 0.2% ropivacaine and the same symptoms resurged. 30 minutes after she gave birth. 1 hour later, symptoms were completely resolved. She remained hemodynamically stable and had no motor block the whole time.
Left ptosis, miosis and conjunctival hyperemia
Conclusions As Horner syndrome is indicative of a high neuraxial block, anesthesiologists need to act with caution as a total spinal anesthesia may develop.