A Case Report: Unilateral Horner’s Syndrome in a Normal BMI Patient Following Labour Epidural Analgesia

 Hira, P1 ; Lassota-Korba, B1 ; Gouda, A1 ; Das, S2 ; Chatterjee, N3

1Yeovil District Hospital, Somerset NHS Foundation Trust; 2Buckinghamshire Healthcare NHS Trust; 3Oxford University Hospitals NHS Foundation Trust

 INTRODUCTION

Horner’s Syndrome (HS) is a rare complication of lumbar epidural analgesia during labour, caused by unintended cephalad spread of local anaesthetic agents.

 CASE PRESENTATION

32-year-old, G1P0, BMI 25.2, mild scoliosis

Epidural: L3–L4, levobupivacaine 0.1% + fentanyl 2mcg/ml via PCEA

Onset: 3 hours post-epidural – left eye itching, ptosis, miosis

No haemodynamic instability or foetal compromise

Analgesia level: T2 (left), T4 (right)

Epidural reduced, remifentanil PCA started

Symptoms resolved in 24 hours

 DISCUSSION

 

1. Incidence of HS with epidurals: 0.13–1.5% (up to 4% in C-sections)
2. Risk factors: Spinal anomalies like Scoliosis, supine position, anatomical variations, pregnancy-related physiological changes
3. Pathophysiology: Common: Cephalad spread of local anaesthetic to cervical sympathetic chain, due to reduction of epidural cavity, rhythmic upward movement of LA owing to uterine contraction. Uncommon: Epidural Septae (2%), Subdural injection of LA
4. Management: Early detection and reassurance, dose reduction, alternative analgesia