title: Transient Horner's syndrome following thoracic epidural anesthesia for mastectomy: a prospective observational study.
abstract: OBJECTIVE
  Transient Horner's syndrome is an uncommon complication of epidural anesthesia, though its exact incidence in thoracic epidural anesthesia is not clear. Therefore, this study prospectively evaluated the incidence of Horner's syndrome after thoracic epidural anesthesia for mastectomy.
  
  
  METHODS
  Patients scheduled for mastectomy, with or without breast reconstruction, were enrolled in this prospective observational study from September 2010 to December 2013. Intraoperative thoracic epidural anesthesia was established using 0.375% or 0.5% ropivacaine 15 mL with thoracic epidural analgesia continued postoperatively with a continuous infusion of 0.15% ropivacaine 2 mL·hr(-1) with fentanyl 8 μg·hr(-1). Signs of Horner's syndrome (miosis, ptosis, and hyperemia) were assessed at one and two hours as well as one, two, and three days postoperatively.
  
  
  RESULTS
  Thoracic epidural anesthesia was successful in 439 patients, with six (1.4%) of these patients acquiring Horner's syndrome. All signs of Horner's syndrome resolved gradually within 180 min of discontinuing the epidural infusion. In one patient with Horner's syndrome, a radiographic contrast injection confirmed that the drug had spread to the cervical epidural level.
  
  
  CONCLUSIONS
  The incidence of Horner's syndrome following thoracic epidural anesthesia and continuous thoracic epidural analgesia for mastectomy was 1.4%. The mechanism was consistent with cephalic spread of the epidural local anesthetic. This trial was registered at: Clinicaltrials.gov, number: NCT02130739.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Soonchunhyang University Seoul Hospital, Seoul, 140-743, Korea, sunnypark97@gmail.com.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Park
authors.forename: Hea Rim
authors.initials: HR
authors.lastname: Chun
authors.forename: Mun Gyu
authors.initials: MG
authors.lastname: Kim
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Sang Ho
authors.initials: SH
authors.lastname: Kim
authors.forename: Si Young
authors.initials: SY
authors.lastname: Ok
authors.forename: Ana
authors.initials: A
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000009:adverse effects*; D015360:Analgesia, Epidural / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006732:Horner Syndrome / Q000139:chemically induced*; D006801:Humans; D015994:Incidence; D008408:Mastectomy; D008875:Middle Aged; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl