[Horner's syndrome following epidural analgesia for labor]

Horner's syndrome is a disorder of the sympathetic nerve supplying the eye. Infrequently, Horner's syndrome can arise as a complication of epidural anesthesia, but its clinical course is favorable. The incidence increases when epidural analgesia is used in obstetrics because of physiological and anatomic changes in obstetric patients that favor spread of the local anesthetic. We report the case of a 31-year-old woman requiring epidural analgesia for labor. She received 10 mL of 0.15% ropivacaine with a bolus dose of 50 microg of fentanyl, followed by epidural catheter infusion of 0.15% and 0.001% fentanyl at a rate of 10 mL/h. Two hours after starting the infusion, the patient's right eye presented a contracted pupil, a drooping eyelid, and enophthalmos, accompanied by flushing on the same side of the face. Horner's syndrome was diagnosed. Signs resolved over the next hour without treatment. The literature contains reports of widely differing incidences of Horner's Syndrome ranging from 1.3% to 75%. The case we report was the only one in our hospital over a period of 4 years during which 12,796 epidural procedures were performed. These data suggest to us that Horner's syndrome often passes undetected because clinical manifestations are not remarkable. Nevertheless, the diagnosis should be kept in mind so that unnecessary treatment is avoided, given that the clinical course is favorable with spontaneous resolution.