Basappji Santhosh, Rohini B. Pai, Raghavendra P. RaoDepartment of Anaesthesiology, SDM College of Health-related Sciences and Hospital, Dharwad, Karnataka, India Address for correspondence: Dr. M. C. B. Santhosh, Department of Anaesthesiology, SDM College of Health-related Sciences and Hospital, Dharwad, Karnataka, India. E-mail: mcbsanthu@gmailA B S T R A C TInterscaleneblockiscommonlyassociatedwithreversibleipsilateralphrenicnerveblock, recurrentlaryngealnerveblock,andcervicalsympatheticplexusblock,presentingas Horner’ssyndrome.WereportaveryrarePourfourDuPetitsyndromewhichhasa clinicalpresentationoppositetothatofHorner’ssyndromeina24yearoldmalewho wasgiveninterscaleneblockforopenreductionandinternalfixationoffractureupper thirdshaftoflefthumerus.Essential words: Horner’s syndrome, interscalene block, Pourfour Du Petit syndromeINTRODUCTION The brachial plexus block by interscalene approach was firstdescribedbyWinnie.5-Bromo-2-(trifluoromethoxy)pyridine Order [1] This method is most useful for surgeries around shoulder.1217603-41-2 web It truly is not uncommon to become connected with reversible ipsilateral phrenic nerve block, recurrent laryngeal nerve block, and cervical sympathetic plexus block, presenting as Horner’s syndrome. We report a case where the patient developed Pourfour Du Petit syndrome (PDPs), which includes a clinical presentation opposite to that of Horner’s syndrome, following interscalene block. CASE REPORT A 24-year-old male with fracture upper third shaft of left humeruswaspostedforopenreductionandinternalfixation. Patienthadaninsignificantpostanestheticexposureforleft inguinohernioplasty under spinal anesthesia. Patient was explained concerning the selection of regional anesthesia for the above surgery and also about the probable complications. He agreed for the brachial plexus block. Patient was 152 cm tall, weighed 70 kg with no coexisting disease, and had typical physical examination and routine investigation.Access this article onlineQuick Response Code:A left brachial plexus block was performed below aseptic precautions by interscalene approach working with a 22-guage, 2-inch insulated needle with extension tube assembly (Stimuplex? B Braun, Melsungen AG, 34209, Melsungen, Germany) soon after localizing the plexus using the support from the nerve stimulator by eliciting motor response at shoulder and upper arm at 0.PMID:24238102 five mA. With all typical monitors, 40 ml of regional anesthetic answer containing 200 mg of lignocaine with 50 adrenaline and 50 mg of bupivacaine was injected gradually more than 5 min. Sufficient sensory and motor block was accomplished. But inside ten min following injection of nearby anesthetic remedy, patient complained of improved sweating within the face and diminished vision in the left eye. On examination, sweating wasconfinedtothelefthalf of thefacewithwidened palpebralfissureof thelefteyeandtheleftpupilwas dilated in comparison towards the right pupil (4 mm/2 mm). Patient was reassured plus the surgery was completed effectively. These symptoms resolved when the plexus functions returned to normal. DISCUSSION PDPs, also known as reverse Horner’s syndrome, is an uncommon focal dysautonomic syndrome characterized by mydriasis, eyelid retraction, and hyperhydrosis. PDPs was firstdescribedbyFrancoisPourfourDuPetit(16641741), a French doctor, in the course of Napoleanic wars in soldiers who showed indicators of improved sympathetic activity in the eyes and upper extremity following slashed wound of neck with sword.[2] He experimentally induced the above situation in dogs by cutting their cervical chain bilaterally.[2] HeVol. 7, Situation 2, April-Ju.