Horner's syndrome and weakness of upper limb after epidural
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Horner's syndrome is not rare during labour epidural analgesia or in pregnant patients receiving epidural anaesthesia for caesarean section as thought previously. It occurs due to blockade of sympathetic fibres supplying the eye and face area. Most of the times it is a benign and self-limiting condition; however, it may become a serious systemic manifestation. We present a case where patient had weakness of upper-limb and Horner's syndrome of same side with visual disturbances. These symptoms were transient and resolved spontaneously without any treatment.

Case :
A 27-year-old (74 kg, 160 cm) female patient, primigravida with no co-morbid conditions was admitted to labour room in active labour and requested pain relief. Examination revealed adequate pelvis, 3.5 cm cervical dilatation with good effacement (approximately 80%). Epidural analgesia was administered by inserting 18G epidural catheter at L3/L4 interspace in sitting position using loss of resistance to saline technique, and fixing-up the catheter at skin keeping 5 cm in epidural space.[4] After negative aspiration of catheter for blood or cerebrospinal fluid, 3 mL test dose of 0.25% bupivacaine was given.[4] After 5 min when subarachnoid injection was ruled out (sensory or motor effects in lower limbs), 9 mL 0.125% bupivacaine was given and infusion of 0.08% bupivacaine with fentanyl (1.66 ?g/mL) was started at the rate of 10 mL/h. Initial visual analogue scale (VAS) score (VAS 0-10, 0 = no pain and 10 maximum pain) was 10/10 and after 20 min it was 5/10 and after 30 min it came down to 3/10. She had good pain relief and progress during next 4 h. During 5th h decision for operative delivery was taken due to signs of foetal distress. Epidural infusion was stopped (after 4 h and 18 min of initiation) and patient was shifted to operation theatre.....