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Background and Aims Supraclavicular brachial plexus block is frequently performed for surgery of the upper limb distal to the shoulder. Possible complications include pneumothorax, phrenic nerve blockade, vascular punctures, intravascular injection, recurrent laryngeal nerve blockade and Horner’s Syndrome. The latter is a rare complication which arises from local anesthetic spread to the ipsilateral cervical sympathetic chain.

Methods Case report.

Results A 32-year-old female, classified as American Society of Anesthesiologists physical status I, presented to the operating room for surgical treatment of a diaphyseal fracture of the distal phalanx of the third finger of the left hand, sustained during a surfing accident. The patient underwent osteosynthesis of the distal phalanx with Kirschner wires under regional anesthesia and light sedation. A supraclavicular brachial plexus block was performed under ultrasound guidance with 23 mL of 0.75% ropivacaine. The block took full effect approximately 30 minutes after local anesthetic injection and the block distribution was adequate. Approximately 1 hour after the performance of the block, at the end of the surgery, the patient developed anisocoria, with miosis of the left eye, ptosis and anhidrosis, findings indicative of Horner’s Syndrome. The symptoms resolved with regression of the nerve block over less than 24 hours. There were no further complications.

Conclusions Supraclavicular brachial plexus block is a safe and effective technique for upper limb surgery. Horner’s Syndrome is usually a benign and self-limited complication which has been reported with an incidence of approximately 1% after supraclavicular brachial plexus block.