Background and methods: A healthy pregnant woman underwent labor under successful epidural analgesia with a total drug mass of 100 mg plain bupivacaine plus 100 micrograms fentanyl in three doses given over 150 minutes.
Results: Ninety minutes after the last dose, she developed signs and symptoms of a left trigeminal nerve block along with an ipsilateral Horner's syndrome. The cutaneous anesthesia level reached C6 on the left and T6 on the right side. Neurologic symptoms disappeared four hours later.
Conclusion: An excessive upward epidural extension of bupivacaine block, reaching the trigeminal spinal nucleus and/or tract in the cervical spinal cord, is postulated.