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

Abstract

Interventional spine procedures are nonsurgical interventions that are commonly used to treat acute and chronic pain. These procedures generally are considered to be safe, but patients may experience transient and minor complications. Hiccups previously have been reported in the pain management setting as a complication after lumbar and thoracic epidural steroid injections and an intrathecal morphine pump infusion. In this case series of 8 patients, we describe hiccups after various interventional procedures, including cervical and lumbar epidural steroid injections, facet joint injections, and sacroiliac joint injections. A comprehensive literature review of hiccups associated with interventional pain procedures is provided, along with the known pathophysiology, etiologies, and treatment options for hiccups. The objective of this case series presentation and literature review is to highlight the importance of recognizing hiccups as a potentially under-reported adverse reaction in the setting of various interventional spine procedures.

Safe Use of Epidural Corticosteroid Injections: Recommendations of the WIP Benelux Work Group

“…Persistent hiccup, probably due to the stimulation of the afferent hiccup reflex curve of the phrenic nerve, vagal nerve, or sympathetic nerves of T6–T12, disappears with conservative measures or chlorpromazine …”

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

“…Several studies have addressed pharmacologic treatment of persistent hiccups after interventional pain procedures. Abbasi et al [3] noted that 6 of 8 patients who developed hiccups after interventional spine procedures had their hiccups resolve spontaneously or after the aforementioned nonpharmacologic treatments. However, the 2 patients with persistent hiccups were treated successfully with chlorpromazine.…”

“…In a case series of 8 patients, Abbasi et al [3] described hiccups after interventional pain procedures including cervical and lumbar epidural steroid injections, facet joint injections, and sacroiliac joint injections. It is unclear whether hiccups are the result of the procedure itself, the anesthetic/steroid, or the physiologic effect of the local anesthetic in the epidural space.…”

Epidural Steroid Injections: An Updated Review on Recent Trends in Safety and Complications

“…Flushing may occur during both interlaminar and transforaminal injections due to an IgE-mediated mechanism, with rates ranging from as low as 0.1% [67,72] to up to 11% [73], and may be prevented by prophylactic antihistamine medication. Persistent hiccups, likely due to stimulation of the afferent hiccup reflex arc involving either the phrenic, vagus or sympathetic nerves of T6-T12, typically resolve with conservative measures or chlorpromazine (Table 1) [74].…”

“…[75] † Nerve damage 0 0/2376 [67] 0 0/301 [67] 0 0/301 [67] 0 0/301 [67] 0 0/301 [67] Intradiscal injection 0.0 1/4723 [76] 0.2 14/8132 [77] 0.2 6/2412 [76] 12.4 31/249 [78] Vasovagal reaction ‡ 0.0 1/2376 [67] 0.3 1/301 [67] 0 0/1450 [67] 0.1 1/1310 [67] 0 0/3985 [67] 8.4 21/249 [65] 0.8 2/249 [65] 1.6 2/123 [66] 1.7 6/157 [79] 0-4 [74] Dural puncture 0.3 1/157 [80] 1.3 4/301 [67] 0.1 2/1450 [67] 0 0/1310 [67] 0.0 1/3985 [67] 0.8 2/249 [65] 0.8 2/249 [65] 1.0 24/2376 [67] Postdural puncture headache § 8.3 2/24 [67] 25 1/4 [67] 9 1/11 [67] 0 0/1310 [67] 0 0/1 [67] Paresthesias/ radicular pain 0.3 6/2376 [67] 0.3 1/301 [67] 0.3 4/1450 [67] 4.6 60/1310 [67] 0.0 0/3985 [67] 7.2 18/249 [65] 13.2 33/249 [65] Flushing 0.1 2/2376 [67] 0.3 1/301 [67] 0.1 2/1450 [67] 11.3 27/240 [73] 0 0/3985 [67] 1.5 5/157 [79]…”