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eComment: Post-thoracotomy Horner syndrome associated with extrapleural infusion of bupivacaine

National Cardiothoracic Centre, Korle Bu Teaching Hospital, PO Box KB 846, Korle Bu, Accra, Ghana

Post-thoracotomy Horner syndrome associated with extrapleural infusion of local anesthetic

Blechman and Zervos report [1] a rare case of Horner's syndrome associated with extrapleural bupivacaine infusion for postoperative pain relief after thoracotomy. Horner's syndrome has been reported [2] infrequently with extrapleural paravertebral nerve blocks but has not been reported in extrapleural intercostal infusions. Karmakar and colleagues [2] however, had one case of Horner's syndrome among 20 infants who had intraoperatively, direct vision inserted paravertebral catheters for postoperative pain relief.

Transient ipsilateral Horner's syndrome can also develop from the upward spread of local anaesthetics to the stellate ganglion or to the preganglionic fibres of the thoracic sympathetic chain. Sympathetic block usually occurs with paravertebral and epidural infusions. The position of the patient may be important as Karmarkar [3] has indicated that spread of contrast medium from the thoracic paravertebral region to the cervical region can occur.

Complications of extrapleural bupivacaine infusions have been well documented. This is related to the site of the catheter location, the concentration of the infusion as well as the rate of infusion. The infusion rate used by Blechman and Zervos was well within the recommended infusion rate for extrapleural infusions [3].

It is, therefore, important that patients who have extrapleural infusions of local anaesthetic drugs be monitored for Horner's syndrome which though relatively rare does occur.

	References

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1. Blechman KM, Zervos M. Post-thoracotomy Horner syndrome associated with extrapleural infusion of local anesthetic. Interact CardioVasc Thorac Surg 2009;9:309–310.[Abstract/Free Full Text]
2. Karmakar MK, Booker PD, Franks R, Pozzi M. Continuous extrapleural bupivacaine for post-thoracotomy analgesia in young infants. Br J Anaesth 1996;76:811–815.[Abstract/Free Full Text]
3. Karmakar MK. Thoracic paravertebral block. Anesthesiology 2001;95:771–780.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frank Edwin Mark M. Tettey Kwabena Frimpong-Boateng Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Aniteye, E. A. Articles by Frimpong-Boateng, K. Search for Related Content PubMed PubMed Citation Articles by Aniteye, E. A. Articles by Frimpong-Boateng, K. Related Collections Related Article