Persistent Hiccup Associated with Thoracic Epidural Injection

Abstract

Epidural steroid injections are commonly used to treat lumbosacral radicular and discogenic pain. When used in this manner, these agents can cause minor, transient systemic side effects and rarely result in any serious complications. Because adverse reactions are uncommon and transient, epidural injections are considered a safe therapeutic intervention. We describe the first case of persistent hiccups as a consequence of a thoracic epidural steroid injection in a patient with thoracic discogenic pain.

Persistent Hiccups After an Epidural Steroid Injection Successfully Treated With Baclofen: A Case Report

“…One patient's hiccups ceased with one 10‐mg dose of chlorpromazine, and the other resolved within 16 hours of chlorpromazine,10 mg orally every 6 hours [3]. In a case report by Slipman et al [2], hiccups after an epidural injection were not relieved with nonpharmacologic treatment or chlorpromazine, 10 mg orally every 6 hours. At 2.5 days after the start of chlorpromazine, the patient's medication was changed to metoclopramide, 10 mg orally every 6 hours, and within 24 hours of this change, his hiccups resolved.…”

“…At 2.5 days after the start of chlorpromazine, the patient's medication was changed to metoclopramide, 10 mg orally every 6 hours, and within 24 hours of this change, his hiccups resolved. In addition, the patient developed hiccups after a second epidural injection, which was again treated successfully with 4 doses of metoclopramide, 10 mg orally every 6 hours [2].…”

Persistent Hiccups After Interventional Pain Procedures: A Case Series and Review

“…The general consensus across disciplines is that these interventional pain procedures are safe, and most adverse events are considered to be minor complications [1,4‐9]. Hiccups already have been reported as a complication after lumbar and thoracic epidural steroid injections [10,11] and intrathecal morphine pump infusion [12] but may be an under‐reported phenomenon with regard to other interventional pain procedures. Table 1 summarizes previous case studies of hiccups reported after interventional pain procedures [10‐12].…”

“…Slipman et al [11] reported a case of a patient who experienced persistent hiccups after transforaminal thoracic epidural steroid injections with betamethasone and diluted lidocaine (Table 1), which was attributed to the well‐documented systemic effects of steroids. Because of the confirmation of injectate flow in the epidural space and dorsal to the vertebral body with fluoroscopic guidance, Slipman et al rationalized that the injectate did not reach the T6‐T12 sympathetic afferent chain, which triggers the hiccup reflex arc.…”

Reply to: Management of intraoperative hiccups with intravenous promethazine

“…Although they reported that there was only one case report about promethazine use for the treatment of hiccups, they did not indicate any references. [3] It may be valuable for the treatment of hiccups, which develop in regional anesthesia and for a limited time during operations and which impair surgical comfort. We thank the author for their contribution.…”