Zespół Hornera w trakcie znieczulenia zewnątrzoponowego porodu – opis przypadku

*Elżbieta Nowacka¹, Wiesław Schubert², Julia Zaręba-Szczudlik², Nikola Niewęgłowska², Piotr Szczudlik³

Summary
Background.Horner´s syndrome is a clinical manifestation of sympathetic denervation of the eye and comprises three main features: ptosis, myosis and enophtalmos. This phenomenon occurring during obstetric epidural analgesia could be the first sign of a high sympathetic blockade resulting in potential maternal-fetal morbidity.
Case report. A 24-year-old primagravida received epidurally 10 ml of 0.1% bupivacaine with 50 ?g fentanyl via the L₃/L₄ interspace, resulting in a sensory block reaching to Th₆ on the right side and to Th₄ on the left side. Ten minutes later, transient foetal bradycardia was noted which resolved after changing her position and administering oxygen via a facemask. At the same time, a left sided Horner´s syndrome developed lasting 80 minutes before resolving completely. The general condition of the patient remained satisfactory, and 2 hours after the epidural injection, an infant with an Apgar score of 10 was delivered using a vacuum extractor. No pathologic sequelae were observed.
Discussion. Horner´s syndrome may occur during obstetric epidural anaesthesia and is not usually associated with major side effects. A high sympathetic block is frequent in parturients and Horner´s syndrome may precede more serious cardiovascular manifestations.

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