A Case Report of Horner's Syndrome in Labour Neuroaxial Analgesia: Diagnosis, Management and Follow-Up.

Abstract

Background and Clinical Significance: Horner's syndrome is an uncommon but recognised complication of neuroaxial analgesia in obstetric procedures, with an incidence of 0.4-4%. Case Presentation: This case report describes a 28-year-old primigravida who developed unilateral Horner's syndrome approximately one hour after lumbar epidural analgesia placement for labour pain relief. Upon examination the patient presented with left-sided ptosis, anisocoria, and unexpected sensory blockade extending to the T3-T4 level, accompanied by localised numbness in the left breast and transient upper limb paraesthesia. The pathophysiology of Horner's syndrome involves cephalad spread of local anaesthetic toward the superior cervical sympathetic chain, disrupting sympathetic innervation to the ocular and facial areas. Primary and secondary damage to the sympathetic pathways in the central nervous offer a wide differential diagnosis. The management was conservative, including reduction in epidural bolus infusion rates and careful monitoring. The patient experienced complete resolution of all symptoms within five hours and delivered vaginally without complications. Conclusions: This case demonstrates the characteristically benign and self-limited nature of this complication, emphasising the importance of clinical awareness, proper reassurance of patients, and avoidance of unnecessary diagnostic testing.