Development of Horner Syndrome Following Inadvertent Subdural Catheterization for Labor Analgesia: A Case Study

This case study discusses the adverse outcome of Horner syndrome in a 31-year-old parturient receiving epidural analgesia for labor. Thirty minutes after placement of an epidural catheter, the patient presented with signs of a high unilateral sensory block. Miosis, ptosis and unilateral shivering confirmed the development of Horner syndrome, suggesting subdural catheter placement. The local anesthetic and opioid infusion were discontinued and the catheter promptly removed with the tip intact. The labor course quickly progressed, and the patient delivered before the catheter was replaced. The neonate was unaffected by their mother's Horner syndrome, earning an APGAR score of 9 at each minute and five minute intervals after birth. Signs of Horner syndrome resolved after three hours and the patient was without neurologic deficits. A literature review was conducted to describe and understand the incidence and management of Horner syndrome. Future studies are recommended to develop a more standardized regimen in early detection and treatment of inadvertent subdural catheter placement.