A Case Report: Incidental Subdural Catheter Placement Complicated by Horner's Syndrome Following Epidural Anesthesia

Epidural anesthesia is commonly used for labor analgesia, but complications such as subdural catheter placement, although rare, can occur. This case report describes a patient who experienced neurological symptoms, including Horner's syndrome, likely caused by incidental subdural catheter placement after an epidural procedure.

A 32-year-old female, G3P1011, at 37 weeks gestation, presented for scheduled induction of labor due to gestational hypertension. The combined spinal-epidural (CSE) procedure was performed at the L3-L4 intervertebral space without complications initially. However, approximately 1 hour later, the patient developed leftsided facial drooping, left arm weakness, numbness around the mouth, and hypotension. The epidural was initially stopped and repositioned due to suspected subdural catheter placement and later restarted at a reduced infusion rate of 1 mL/hr. Over several hours, the patient's symptoms improved, and she progressed to full cervical dilation. She delivered a healthy baby vaginally without further complications. The patient's neurological symptoms fully resolved by 6 hours post-procedure.

This case highlights the rare complication of subdural catheter placement during epidural anesthesia. The patient's symptoms, including an atypical sensory block and mild motor involvement, were consistent with a subdural block and improved with supportive care, including cessation of the epidural infusion, phenylephrine, and fluid resuscitation. Although subdural catheter placement is rare, it should be considered in the differential diagnosis for patients with unexpected neurological symptoms after epidural anesthesia. Early recognition and management are crucial for preventing complications and improving patient outcomes. In this case, prompt intervention led to complete resolution of symptoms.