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Transient Horner Syndrome Following Epidural Anesthesia for Labor: Case Report and Review of the Literature

Barbara, Ramez MBChB*†; Tome, Riad MD; Barua, Ankur MBChB§; Barbara, Adel MD; Gaitini, Luis MD; Odeh, Marwan MD†∥; Garzozi, Hanna MD*†

Obstetrical & Gynecological Survey: February 2011 - Volume 66 - Issue 2 - p 114-119
doi: 10.1097/OGX.0b013e31821d6e5c

Epidural anesthesia is a widely used method for pain control during labor; nevertheless, it is not without risks. Horner syndrome is an uncommon related complication. We report a case of transient Horner syndrome following epidural anesthesia and a review of the literature. We discuss the pathophysiologic and contributing factors to this syndrome and its potential complications.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this activity, physicians will be able to educate healthcare professionals working on the labor ward to be able to estimate the small incidence of Horner Syndrome following epidural anesthesia administered in labor. This will result in optimal management and will minimize the need for costly and inappropriate diagnostic investigations. The reader will also be able to compare the difference in the incidence of Horner syndrome following epidural anesthesia, as reported in the literature; appraise the clinical presentation, the pathophysiology, and the mechanism of Horner syndrome developing as a complication of regional anesthesia; and analyze the different theories proposed in the reported cases in the literature.

*Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel; †Rappaport Faculty of Medicine, Technion, Haifa, Israel; ‡Department of Anesthetics, Bnai Zion Medical Center, Haifa, Israel; §Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, United Kingdom; ¶Department of Ophthalmology, Hadassah Optimal Medical Center, Haifa, Israel; and ∥Department of Obstetrics & Gynecology, Western Galilee Hospital, Nahariya, Israel

Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2011. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commerical organizations pertaining to this educational activity.

Correspondence requests to: Ramez Barbara, MBChB, Department of Ophthalmology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.