Horner's syndrome as a complication of lumbar epidural block

Abstract

Horner's syndrome is a well-recognised complication of regional analgesia in the neck and shoulder region but it is not often encountered as a complication of blocks performed elsewhere. This is a report of the details of two patients who developed Horner's syndrome after lumbar epidural blocks. Case historiesCase 1 A 25-year-old mother, weight 69 kg and height 152 cm, had a lumbar epidural block performed 2 hours after labour had been induced by amniotomy and the intravenous infusion of oxytocin. The epidural block was performed between the second and third lumbar spinous processes, with the patient lying on her left side. A cannula (Portex) was passed via a Tuohy needle 3 cm into the epidural space. Eight ml of 0.5% bupivacaine, without adrenaline, was given through the cannula and produced virtually complete analgesia; some pain persisted and was felt suprapubically on the right side. Cutaneous sensory loss to pin prick was present on the left side only and extended from L3 to T6.Twenty-five minutes after the first injection a second injection of 4 ml of 0.5% bupivacaine was made with the patient lying on her right side. Complete analgesia was produced and cutaneous sensory loss extended from L3 to T6 on the left side and from Ll to T11 on the right side. A further two doses of 4 ml and 5 ml were given l+ and 3 hours later; the fourth dose was given with the patient sitting up since cervical dilatation had reached 9 cm. Cutaneous sensory loss extended from L3 to T7 on both sides after the fourth injection.The foetal head persisted in the occipito-posterior position in the second stage of labour and maternal effort produced poor progress. After 30 minutes in the second stage the patient was placed in the lithotomy position and prepared for a manual rotation and forceps delivery. It became apparent during the preparation of the patient

An Extensive Lumbar Epidural Block

“…The mechanism for sympathetic blockade may be related to fibre sensitivity, the B fibres being somewhat more sensitive than the A and C fibres of pain and temperature. 9 Conversely, dilated pupils have been noted with subdural anaesthetic implicating third nucleus involvement and as previously noted the subdural space is continuous intracranially. In this case, regrettably, no observation of pupil size was made which may have been of help in localising the position of injection.…”

Delayed Horner's syndrome during a continuous infraclavicular brachial plexus block

“…Apart from the fact that it can precede high spinal (or epidural) block and cardiovascular collapse in special situations [4], Horner's syndrome is typically of no clinical consequence to the patient.…”

Ervervet Horners syndrom

“…Hos én pasient var det også en liten ipsilateral lesjon i insula (9). Informasjon av emosjonell og sensorisk karakter, spesielt via insula og amygdala, ender i posterolaterale del av hypothalamus, og nyere data tyder på at den sentrale delen nialt) (13). Klassisk er det forårsaket av en tumor naer lungetoppen som gir nevrogen smerte i arm, atrofi i hånd, Horners syndrom og destruksjon av øvre ribbein, et syndrom beskrevet av Pancoast i 1932 (14).…”