Persistent Hiccups Associated with Epidural Ropivacaine in a Newborn

Bagdure, Dayanand; Reiter, Pamela D.; Bhoite, Girija R.; Dobyns, Emily L.; Laoprasert, Pramote

doi:10.1345/aph.1p760

Cited by 13 publications

(8 citation statements)

References 20 publications

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“…The addressed mechanisms included the interruption of inhibitory reflex of phrenic nerve motor drives and direct de-afferentation of visceral sensory pathway resulting in increased diaphragmatic activities and hiccups 39,40. An infant using epidural ropivacaine in a fistula surgery developed persistent hiccup in a dose dependent manner and it rapidly subsided in a low dose infusion 6. Overall, it is uncertain whether some cases of post-operative hiccups are the effect of direct surgery or secondary to anesthetic agents.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

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Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. The abrupt air rush into lungs elicits a "hic" sound. Hiccup is usually a self-limited disorder; however, when it is prolonged beyond 48 hours, it is considered persistent whereas episodes longer than 2 months are called intractable. A reflex arc involving peripheral phrenic, vagal and sympathetic pathways and central midbrain modulation is likely responsible for hiccup. Accordingly, any irritant in terms of physical/chemical factors, inflammation, neoplasia invading the arc leads to hiccups. The central causes of hiccup include stroke, space occupying lesions and injury etc, whereas peripheral causes include lesions along the arc such as tumors, myocardial ischemia, herpes infection, gastroesophageal reflux disease and applied instrumentations on human body etc. Besides, various drugs (eg, anti-parkinsonism drugs, anesthetic agents, steroids and chemotherapies etc) are the possible etiology. An effective treatment of persistent hiccup may be established upon the correct diagnosis of lesion responsible for the serious event. The pharmacotherapy of hiccup includes chlorpromazine, gabapentin, baclofen, serotonergic agonists, prokinetics and lidocaine. Non-pharmacological approaches such as nerve blockade, pacing, acupuncture and measures to hold breathing are also successful. Finally, alternative medicines and remedies are convenient to treat hiccups with uncertain effect. In conclusions, hiccup is likely to result from lesions involving the hiccup reflex arc. The lesion may need to be localized correctly for ablative treatment in patients with intractable hiccup. Apart from lesion ablation, drugs acting on reflex arc may be effective, while some other conventional measures may also be tried.

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Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

“…Hiccup occurrence is not only confined to the adults but also observed among the infants5,6 and children 7. It is usually a self-limited disorder meaning many episodes would subside spontaneously without any clinical significance.…”

Section: Introductionmentioning

confidence: 99%

Hiccup: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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“…Acute hiccups are defined as a hiccupping episode that lasts for minutes to hours; persistent hiccups last for more than 48 hours; and intractable hiccups last for more than 1 month. Hiccups are not only confined to adults but are also observed among infants [3,4] and children [5]. …”

Section: Introductionmentioning

confidence: 99%

Baclofen for stroke patients with persistent hiccups: a randomized, double-blind, placebo-controlled trial

Zhang

et al. 2014

Trials

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BackgroundThe results of preclinical studies suggest that baclofen may be useful in the treatment of stroke patients with persistent hiccups. This study was aimed to assess the possible efficacy of baclofen for the treatment of persistent hiccups after stroke.MethodsIn total, 30 stroke patients with persistent hiccups were randomly assigned to receive baclofen (n = 15) or a placebo (n = 15) in a double-blind, parallel-group trial. Participants in the baclofen group received 10 mg baclofen 3 times daily for 5 days. Participants assigned to the placebo group received 10 mg placebo 3 times daily for 5 days. The primary outcome measure was cessation of hiccups. Secondary outcome measures included efficacy in the two groups and adverse events.ResultsAll 30 patients completed the study. The number of patients in whom the hiccups completely stopped was higher in the baclofen group than in the placebo group (relative risk, 7.00; 95% confidence interval, 1.91–25.62; P = 0.003). Furthermore, efficacy was higher in the baclofen group than in the placebo group (P < 0.01). No serious adverse events were documented in either group. One case each of mild transient drowsiness and dizziness was present in the baclofen group.ConclusionsBaclofen was more effective than a placebo for the treatment of persistent hiccups in stroke patients.Trial registrationChinese Clinical Trials Register: ChiCTR-TRC-13004554

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“…Acute hiccups often last for minutes to hours; persistent hiccups last for more than 48 h, but less than a month; and intractable hiccups last for more than 1 month. Anyone can experience hiccups, from infants to adults …”

Section: Introductionmentioning

confidence: 99%

“…Anyone can experience hiccups, from infants to adults. [3][4][5] A wide range of pharmacological interventions for intractable hiccups include baclofen, 6,7 gabapentin, [8][9][10][11] chlorpromazine, 12,13 haloperidol 14 and carvedilol. 15 Several previous clinical studies have reported that metoclopramide may help treat intractable hiccups.…”

Section: Introductionmentioning

confidence: 99%