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.
Conclusions As Horner syndrome is indicative of a high neuraxial block, anesthesiologists need to act with caution as a total spinal anesthesia may develop.