Kombine spinal-epidural anesteziden sonra tek taraflı horner sendromu (Olgu sunumu)

Unilateral horner syndrome following combined spinal-epidural anaesthesia

Horner syndrome is a rare, unpredictable neurological and opthalmological complication of epidural anaesthesia with spontaneous and full regression frequently. Combined spinal-epidural anaesthesia was performed to a 46 year old, 160 cm height, 55 kg, ASA II class, female patient, undergoing surgery for pelvic relaxation. Spinal block was obtained by infusion of 15 mg (0.5 %) heavy bupivacaine, an epidural catheter was placed at the L3-4 level in right lateral decubitis position. Sensory blockade with pinprick, test reached the T12 level at right, T10 level at left site, motor blockade with Bromage scale was 3 at right, 2 at left site. Hemodynamic variedates were stable perioperatively. After 2 hours following spinal block when verbal pain score was 3; 7 mL 0.25 % bupivacaine was injected via epidural catheter for postoperative analgesia. Motor weakness of the left leg, myosis and ptozis at the left site were observed one hour later. Neurologic symptoms were resolved completely within 11 hours following the procedure. High sympathetic blockage, litotomy position, use of bupivacaine were thought to be responsible for the development of Horner syndrom after lumbar epidural anaesthesia. Although in our case, lithotomy position and bupivacaine were used, sympathetic blockade didn't extend above the T10 level. Longer duration of motor blockade at the left site recognized that replacement of catheter tip to the left instead of cephalic direction may play a role in the accurance of Horner syndrome. Syndrome showed spontaneous and full regression.

___

  • 1. Day CJE, Shutt LE: Auditory, Ocular, and Facial Complications of Central Neural Block. Reg Anesth 1996; 21(3):197-201.
  • 2. Clayton KC: The incidens of Horner’s syndrome during lumbar extradural anesthesia for elective cesarean section and provision of analgesia during labour. Anaesthesia 1988; 88:583-5.
  • 3. Biousse V, Guevara RA, Newman NJ: Transient Horner’s syndrome after lumbar epidural anesthesia. Neurology 1998; 51:1473-5
  • 4. Buchheit T, Crews JC: Lateral cervical epidural catheter placement for continuous unilateral upper extremity analgesia and sympathetic block. Reg Anesth Pain Med 2000; 25(3):313-7.
  • 5. Finucane BT: Complications of Regional Anesthesia. C Livingstone. New York 1999; p.238.
  • 6. Cozanitis DA: Leg pains after spinal anaesthesia. Can J Anaesth 1995; 42(7):657.
  • 7. Fan K, Morris I: Horner’s syndrome due to epidural analgesia. Can J Anaesth 1998; 45(12):1219.
  • 8. Chan YK, Gopinathan R and Rajendram R: Loss of consciousness folowing spinal anaesthesia for caeserian section. Br J Anaest 2000; 85(3):474-6.
  • 9. Vandermeulen E, Gogarten W, Van Aken E: Risks and complications following peridural anesthesia. Anaesthesist (Germany) 1997; 46(3):179-86.
  • 10. Hered RW, Cummings RJ, Helffrich R: Persistent Horner’s syndrome after spinal fusion and epidural analgesia. A case report. Spine 1998; 23(3):387-90.