Brudny P, Leben J, Schregel W, Neuhaus W
Abteilung Anästhesie und Intensivmedizin, St. Josefshopital Uerdingen.
Anasthesiol Intensivmed Notfallmed Schmerzther. 1999 Aug;34(8):510-2. doi: 10.1055/s-1999-200.
A 28 year old primipara (37th gestational week) was scheduled to undergo delivery by caesarean section under epidural anaesthesia. An epidural catheter was easily inserted in the L3/L4 interspace. After a negative aspiration test 5 ml of bupivacaine 0.25% plus adrenaline 1:200,000 were injected and five minutes later 2 x 5 ml of bupivacaine 0.5% plus fentanyl 0.005 mg/ml were given. Ten minutes after the test dose the patient reported warmth and paraesthesia in the right leg and pelvis and numbness in the right periorbital region. The catheter was drawn back 1.5 centimeters and the operation could be performed under regional anaesthesia with supplemental doses of bupivacaine. Sensory level at the end of the operation was Th 4 which decreased continuously in the following two hours. Ocular symptoms (miosis, ptosis, right-sided numbness) as well as numbness in the right hand and leg persisted four hours longer. The most probable explanation for this peripheral Horner's syndrome is a subdural blockade caused by the first bupivacaine doses. The only known prophylaxis is a fractioned epidural injection of local anaesthetics.
一名28岁初产妇（孕37周）计划在硬膜外麻醉下行剖宫产术。硬膜外导管很容易地插入L3/L4间隙。在回抽无血无脑脊液试验阴性后，注入5毫升0.25%布比卡因加1:200,000肾上腺素，5分钟后给予2×5毫升0.5%布比卡因加0.005毫克/毫升芬太尼。试验剂量给药10分钟后，患者诉右腿及骨盆有温热感和感觉异常，右眶周区域麻木。将导管回退1.5厘米，手术可在区域麻醉下用补充剂量的布比卡因进行。手术结束时感觉平面为胸4，在接下来的两小时内持续下降。眼部症状（瞳孔缩小、上睑下垂、右侧麻木）以及右手和腿部麻木持续了4小时。这种周围性霍纳综合征最可能的解释是首次布比卡因剂量导致的硬膜下阻滞。唯一已知的预防措施是分次硬膜外注射局部麻醉药。
