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Abstract
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Background and Aims Horner’s Syndrome (HS), a triad of ptosis, miosis and anhidrosis, is associated with the blockade of oculosympathetic fibres. Even though epidural analgesia is known to be a rare cause of HS, it appears to be most seen in women requiring an epidural during labour or for a caesarean section.
Methods A 32-year-old woman, at 38 weeks of gestation, sought epidural analgesia during active labour. The procedure was performed at L3-L4 interspace, using a saline loss of resistance technique, reaching the epidural space at 5 cm depth. A 2mL test dose of 0.2% ropivacaine with sufentanil was followed by 8mL manual administration. Programmed intermittent epidural bolus (PIEB) of 0.15% ropivacaine was associated with patient-controlled analgesia. After 20 minutes, she experienced right eyelid heaviness and forearm paresthesia. Physical examination showed right ptosis, miosis and conjunctival hyperemia and C8 dermatome sensory block of the ipsilateral side. PIEB bolus was then lowered and tight vigilance was maintained. She had a complete resolution of her symptoms within 30 minutes after delivery, 4 hours later.
Results Two main causes have been suggested to explain the high cephalad spread of local anaesthetics leading to HS during labour: presence of anatomic variations, such as fibrous septae, spinal deformities and post-surgical adhesions or the inadvertent subdural injection of local anaesthetics. Increased intra-abdominal pressure due to gravid uterus, engorgement of the epidural veins and uterine contractions, may further explain its development.
Conclusions Although usually benign, symptoms and signs of HS can indicate more serious complications. Therefore, vigilance of such symptoms is vital.
C8 dermatome sensory block of the right forearm
Right ptosis, miosis and conjunctival hyperemia of the right eye