Recurrent Horner's syndrome following epidural analgesia for labor

Abstract Introduction: Horner's syndrome is an unusual side effect of epidural analgesia. We report an unusual symptom after epineural axis analgesia for labor, which happened three times in the same patient. Horner's syndrome occurrence following epidural catheterization should lead the anesthetic team to search for a subdural position of the catheter because of its potentially threatening complications. Patient's concern: Our patient, a 38 years old pregnant woman, was managed by the anesthetic team for the analgesia of her second labor. Anesthetic consultation pointed out that she had a history of Horner's syndrome after epidural analgesia attempt during her first pregnancy. During our anesthetic management of her second labor, she presented, on the left side of the body, with the same symptom as she had during her first labor a few years ago, associated with high unilateral sensory block after epidural catheterization. After the total regression of neurological signs, a second catheterization attempt was followed by a contralateral isolated Horner's syndrome with no sensory block. Diagnosis: A few minutes after the induction of analgesia, our patient presented left ptosis, meiosis, and enophthalmos associated with a high homolateral sensory block. The subdural catheter position was suspected, and the catheter was removed. Intervention: Because of this repeated unusual complication and because we would not have used the catheter for an emergency C section, we chose to remove it definitively. Outcome: Our patient had a total regression of the symptoms 1 h after the catheter withdrawal. Delivery was rapid, with no complications, and she was discharged from the hospital 3 days after. Conclusion: Our observations suggest the possibility of a potential anatomical particularity of the dural canal in this patient and question the safety of performing an epidural catheterization for further procedures.