[Horner's syndrome secondary to epidural anesthesia].
BACKGROUND
The Horner's syndrome in association with the anesthetic techniques is produced by a blockade of the stellate ganglion sympathetic fibers. This complication is produced by the local anesthetic non-expected migration when it is administered either in the epidural space while performing an epidural block or inside the aponeurosis vascular elements during the performance of a brachial plexus block. Its evolution is quick, with benign incident that disappears in a few hours, without leaving any sequels. It can occur in patients without any previous clinical condition.


METHODS
We described the case of 28 years old pregnant woman, with a body mass index of 40.6, without any previous neurological background, who was admitted into hospital for labour. She had epidural analgesia and needed a caesarean section 2 hours later. Twenty minutes after the administration of an epidural dose of local anesthetic, the patient developed a completed left side Horner's Syndrome, as well as ipsi-lateral brachial paresis, that lasted for three hours, with complete recovery.


CONCLUSIONS
Several etiopathologenic options were considered at the time, such as a possible subdural or paravertebral migration of the local anesthetic, the influence of the patient's position (decubitus) and the possible existence of fibrotic compartments in the epidurals space.
Varela
C
C
Servicio de Anestesiología y Reanimación, Hospital Madrid Montepríncipe, Madrid, Spain.
Palacio
F
F
Reina
M A
MA
López
A
A
Benito-León
J
J
D000328:Adult; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D001132:Arm / Q000294:innervation; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D002585:Cesarean Section; D016640:Diabetes, Gestational; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D006732:Horner Syndrome / Q000139:chemically induced*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D009765:Obesity / Q000150:complications; D010243:Paralysis / Q000139:chemically induced*; D011187:Posture; D011247:Pregnancy; D011677:Punctures / Q000009:adverse effects*; D012021:Reflex, Abnormal
D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl; D002045:Bupivacaine