Bilateral trigeminal nerve palsy during an extensive lumbar epidural block

Two cases of Horner syndrome after administration of an epidural test dose that did not recur with subsequent epidural activation

OBJECTIVE

We describe 2 cases of Horner syndrome after epidural test dose injections in thoracic surgery patients. The Horner syndrome was transient and did not recur with full epidural activation and infusion.

CASE REPORT

Two patients undergoing thoracic surgery procedures received preoperative midthoracic epidural catheters for postoperative analgesia. Following the 3-mL 1.5% lidocaine test dose, a unilateral Horner syndrome was observed. No other signs and symptoms of high epidural blockade were seen, and the Horner syndrome subsequently resolved. After epidurogram confirmation of proper catheter position and at the conclusion of surgery, the epidural was activated with an appropriate bolus and infusion dose without recurrence of the Horner syndrome.

CONCLUSIONS

Two cases of Horner syndrome presenting after administration of an epidural test dose are reported. This uncommon initial finding could not be reproduced with subsequent epidural activation, perhaps suggesting that initial conditions within the epidural space had been altered. Successful utilization of neuraxial regional analgesia was achieved with careful postoperative monitoring of the patients.

Neurological complications in obstetric regional anaesthesia

Neurological complications after obstetric central neural blocks are rare events. Although central neural blockade does cause neurological complications, there must be awareness that neurological deficits may either develop spontaneously (e.g. epidural abscess/haematoma) or as a result of the labour and delivery process (maternal obstetric palsies). We have attempted to review as completely as possible the published survey and case reports in the English literature on neurological complications of obstetric regional blockade obtained from Medline spanning the period 1966 to November 1998. We also performed cross-checking of our references to find important missing articles, e.g. papers published in journals not included in Index Medicus at the time of publication, such as the International Journal of Obstetric Anesthesia. We wish to provide some insight to the incidences, pathophysiology, clinical features, investigations, treatment and prognosis of these complications. Maternal obstetric palsies and case reports of spontaneous epidural abscess/haematoma are also discussed. It is often difficult, if not impossible, to determine the exact aetiology, but unfortunately for the anaesthetists, regional blockade is usually incriminated till proven otherwise. Although we cannot eliminate the occurrence of neurological complications completely, preventive measures can still be taken to decrease their incidence (e.g. aseptic technique). There must also be regular monitoring after neural blockade for the development of neurological complications. Early diagnosis and prompt appropriate treatment will usually lead to complete resolution of the neurological deficit even in cases of epidural haematoma/abscess.