Unilateral horner syndrome following combined spinal-epidural anaesthesia

Abstract

Horner syndrome is a rare, unpredictable neurological and opthalmological complication of epidural anaesthesia with spontaneous and full regression frequently. Combined spinal-epidural anaesthesia was performed to a 46 year old, 160 cm height, 55 kg, ASA II class, female patient, undergoing surgery for pelvic relaxation. Spinal block was obtained by infusion of 15 mg (0.5 %) heavy bupivacaine, an epidural catheter was placed at the L3-4 level in right lateral decubitis position. Sensory blockade with pinprick, test reached the T12 level at right, T10 level at left site, motor blockade with Bromage scale was 3 at right, 2 at left site. Hemodynamic variedates were stable perioperatively. After 2 hours following spinal block when verbal pain score was 3; 7 mL 0.25 % bupivacaine was injected via epidural catheter for postoperative analgesia. Motor weakness of the left leg, myosis and ptozis at the left site were observed one hour later. Neurologic symptoms were resolved completely within 11 hours following the procedure. High sympathetic blockage, litotomy position, use of bupivacaine were thought to be responsible for the development of Horner syndrom after lumbar epidural anaesthesia. Although in our case, lithotomy position and bupivacaine were used, sympathetic blockade didn't extend above the T10 level. Longer duration of motor blockade at the left site recognized that replacement of catheter tip to the left instead of cephalic direction may play a role in the accurance of Horner syndrome. Syndrome showed spontaneous and full regression.