Horner syndrome following epidural analgesia for labor pain:two case reports

Abstract

Horner Syndrome (HS) is a rare but benign complication with epidural analgesia in parturients. It is caused by the cephalad spread of local anesthetic with an overflow to the superior cervical sympathetic chain. We present 2 patients, a 28-year old woman and a 23-year old woman, both without any major medical comorbidity. Each patient received a lumbar epidural catheter with the conventional labor pain treatment of our hospital. The first patient developed HS after the administration of 10 ml of lidocaine 1% when a unilateral block occurred. At this time, the patient was placed in genupectoral position. The second patient developed HS directly after the first bolus of 10 ml of the standard epidural solution of our center when the patient was in supine position. A spontaneous resolution of HS was observed in both patients. The exact incidence of HS in parturients is not known and probably underreported by patients as well as by caregivers. Clinical vigilance and appropriate teaching of obstetrics caregivers is very important. We demonstrate that an accidental subdural placement of the catheter and the dose of the epidural solution can play a major role in the development of HS.Horner Syndrome (HS) is a rare but benign complication with epidural analgesia in parturients. It is caused by the cephalad spread of local anesthetic with an overflow to the superior cervical sympathetic chain. We present 2 patients, a 28-year old woman and a 23-year old woman, both without any major medical comorbidity. Each patient received a lumbar epidural catheter with the conventional labor pain treatment of our hospital. The first patient developed HS after the administration of 10 ml of lidocaine 1% when a unilateral block occurred. At this time, the patient was placed in genupectoral position. The second patient developed HS directly after the first bolus of 10 ml of the standard epidural solution of our center when the patient was in supine position. A spontaneous resolution of HS was observed in both patients. The exact incidence of HS in parturients is not known and probably underreported by patients as well as by caregivers. Clinical vigilance and appropriate teaching of obstetrics caregivers is very important. We demonstrate that an accidental subdural placement of the catheter and the dose of the epidural solution can play a major role in the development of HS.