Recurrent Persistent Hiccups After Epidural Steroid Injection and Analgesia with Bupivacaine

McAllister, Russell K.; McDavid, Andrew J.; Meyer, Tricia A.; Bittenbinder, Timothy M.

doi:10.1213/01.ane.0000153016.82444.20

Cited by 48 publications

(47 citation statements)

References 15 publications

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“…Even an epidural anesthesia using bupivacaine led to repeated hiccup in a patient. 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.…”

Section: Etiology Of Persistent and Intractable Hiccupsmentioning

confidence: 99%

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: Mystery, Nature and Treatment

Chang¹,

2012

J Neurogastroenterol Motil

167

173

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“…In this case study, the hiccups were associated with esophagitis and GERD. Also, metabolic derangements and drugs may also predispose to hiccup [4,7]. …”

Section: Discussionmentioning

confidence: 99%

“…If these methods fail to stop the hiccups, pharmacological methods are attempted. This can include the use of metoclopramide, chlorpromazine, amitriptyline, phenytoin, and valproic acid [4,9]. Recently, baclofen and gabapentin have been introduced for both monotherapy and combined therapy [1,4,5,9].…”

Section: Discussionmentioning

confidence: 99%

“…This can include the use of metoclopramide, chlorpromazine, amitriptyline, phenytoin, and valproic acid [4,9]. Recently, baclofen and gabapentin have been introduced for both monotherapy and combined therapy [1,4,5,9]. In a case-report by Turkyilmaz and Eroglu [10], a patient with a tumor on the esophagogastric intersection had hiccups after stent placement.…”

Section: Discussionmentioning

confidence: 99%

“…However, if they continue for more than 48 hours and up to 1 month, they are called "persistent" hiccups. If they continue more than 1 month, it is called intractable hiccups [1,4]. Traditionally, hiccups are treated via non-invasive pharmacological methods.…”

mentioning

confidence: 99%

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A Case of Pneumothorax after Phrenic Nerve Block with Guidance of a Nerve Stimulator

et al. 2011

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Hiccups have more than 100 etiologies. The most common etiology has gastrointestinal origins, related mainly to gastric distention and gastroesophageal reflux disease. Intractable hiccups are rare but may present as a severe symptom of various diseases. Hiccups are mostly treated with non-invasive or pharmacological therapies. If these therapies fail, invasive methods should be used. Here, we present a patient on whom we performed a blockage of the phrenic nerve with the guidance of a nerve stimulator. The patient also had pneumothorax as a complication. Three hours after intervention, a tube thoracostomy was performed. One week later, the patient was cured and discharged from the hospital. In conclusion, a stimulator provides the benefit of localizing the phrenic nerve, which leads to diaphragmatic contractions. Patients with thin necks have more risk of pneumothorax during phrenic nerve location.

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Complications of Regional Anesthesia in Chronic Pain Therapy

Peng

Chan

2007

Complications of Regional Anesthesia

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Recurrent Persistent Hiccups After Epidural Steroid Injection and Analgesia with Bupivacaine

Cited by 48 publications

References 15 publications

Hiccup: Mystery, Nature and Treatment

Hiccup: Mystery, Nature and Treatment

A Case of Pneumothorax after Phrenic Nerve Block with Guidance of a Nerve Stimulator

Complications of Regional Anesthesia in Chronic Pain Therapy

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