Horner syndrome after epidural analgesia for labor. Report on three cases

Horner's Syndrome Following Dural Puncture Epidural Analgesia for Labor

“…However, cases with bilateral symptoms accompanying trigeminal and hypoglossal nerve palsy, maternal hypotension, and fetal bradycardia have also been reported [ 8 ]. High cephalad spread of local anesthetics has been found to be responsible for transient HS after epidural analgesia, indicating a high-level block interrupting the oculosympathetic pathway [ 2 , 9 ].…”

“…In pregnant individuals, several anatomical and physiological changes have been believed to favor the cephalic spread of the epidural solution. These include increased intra-abdominal pressure due to gravid uterus, uterine contractions, the engorgement of the epidural venous plexus, which reduces the epidural space volume, and elevated progesterone levels that enhance the sensitivity of neuronal membranes to local anesthetics and facilitates the disruption of sympathetic fibers while potentially sparing sensory and motor fibers [ 2 , 9 ]. Inadvertent subdural injection of a low-dose local anesthetic has been suggested as another possible etiology for HS development.…”