Ultrasound-guided phrenic nerve block for intraoperative persistent hiccups: a case report

Zhang, Yong; Duan, Fuhong; Ma, Wuhua

doi:10.1186/s12871-018-0589-2

Cited by 20 publications

(24 citation statements)

References 12 publications

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“…Hiccup creates a pressure gradient across the lower esophageal sphincter (LES) enabling reflux and this could increase the risk for aspiration [ 18 ]. Thus, it becomes imperative that attempts be made to prevent aspiration risks from intraoperative hiccups.…”

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

“…Perioperative hiccup is more commonly induced by various anesthetic techniques and drugs used during anesthesia. Hiccup has been reported in patient receiving epidural anesthesia for vaginal hysterectomy, although this could also be due to excessive uterine stretching stimulating the hiccup reflex [ 18 ]. Epidural anesthesia seems less likely to be the cause for hiccups, because cervical epidural injection of local anesthetics has been used successfully to treat hiccup by blocking the peripheral vagal stimulation [ 5 ].…”

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

“…These drugs include methohexital, thiopentone, midazolam, and opioids [ 2 , 19 ]. Propofol has also been reported to be associated with hiccup, and being successfully treated with lidocaine [ 18 ]. While propofol is routinely used in all age groups, we don’t frequently encounter this complication probably because lidocaine is almost routinely administered prior to propofol to prevent pain on injection with propofol [ 20 ].…”

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

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Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

Mathew

Shen

Liu

2019

Transl Perioper & Pain Med

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Hiccup is an involuntary contraction of the diaphragm and intercostal muscles resulting in sudden inspiration and closure of the glottis. The presence of hiccup in the perioperative period can be a challenging problem. Sudden movements of the patient from hiccups can interfere preoperative diagnostic procedures, intraoperative hiccup may delay the beginning of surgery, interfere with the surgical process, and affect intraoperative monitoring, and postoperative hiccup may affect would healing and hemodynamic stability. Hiccup can lead to have increased aspiration risk. Hiccup are is an incompletely understood phenomenon with multiple etiologies. Intraoperative hiccup related to laryngeal mask airway placement has been reported, and it presents unique challenges in diagnosis and management. Both pharmacological and non-pharmacological interventions have been utilized with various level of success. All treatment strategies are primarily aimed at interrupting the hiccup reflex arc.

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Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

Section: Physiological Mechanism Of Hiccupmentioning

confidence: 99%

See 1 more Smart Citation

Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

Mathew

Shen

Liu

2019

Transl Perioper & Pain Med

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“…Case reports have provided mixed results of the efficacy of phrenic nerve blocks for treatment of intractable hiccups. 4 , 9 , 10 This may be the result of differences in block techniques or causes of hiccups. The approach of placing a phrenic nerve catheter described above and the improvement in symptoms may have utility in other cases where intractable hiccups place patients at risk for wound dehiscence and subsequent reoperation.…”

Section: Discussionmentioning

confidence: 99%

Regional Anesthesia to the Rescue: Phrenic Nerve Block to Prevent Wound Dehiscence From Intractable Hiccups—A Case Report

Rafizadeh¹,

Schenk²,

Champion³

et al. 2021

A&A Practice

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Increased intra-abdominal pressure (IAP) following large abdominal surgeries can lead to postoperative complications, including wound dehiscence and surgical reoperation. Numerous factors can contribute to increased postoperative IAP, and intractable hiccups have been implicated as a culprit. Different treatment modalities have been widely used with variable success in addressing intractable hiccups. Here, we present a case in which postoperative hiccups leading to wound dehiscence and reoperation were successfully treated with an indwelling phrenic nerve catheter. Following placement, a significant reduction in hiccup severity and frequency was noted, improving the patient’s quality of postoperative course and preventing further surgical intervention.

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“…For lesions close to the diaphragm, an added right phrenic nerve block may be necessary (taking into consideration the possibility of paralyzing the diaphragm, resulting in a high position of the liver. 12 If a hepatic hilar nerve block is not possible, such as if the hilum is occupied by a mass, a celiac plexus block or splanchnic block may warrant consideration. Brief descriptions of these techniques are described below.…”

Section: Techniquementioning

confidence: 99%

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

Liu

Hadjivassiliou

Valenti

et al. 2020

Journal of Interventional Medicine

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Percutaneous image guided thermal ablation has become a cornerstone of therapy for patients with oligometastatic disease and primary liver malignancies. Evolving from percutaneous ethanol injection (PEI), thermal ablation utilizing radiofrequency ablation (RFA) and microwave ablation (MWA) have become the standard approach in the treatment of isolated lesions that fit within the size criteria for curative intent therapy (typically 3-4cm). With the evolution of more intense thermal ablation, such as MWA, the dramatic increase in both the size of ablation zone and intensity of heat generation have extended the limits of this technique. As a result of these innovations, intra-procedural and post-procedural pain have also significantly increased, requiring either higher levels of intravenous sedation or, in some institutions, general anesthesia. In addition to the increase in therapeutic intensity, the use of intravenous sedation during aggressive ablation procedures carries the risk of over-sedation when the noxious insult (i.e. the ablation) is removed, adding further difficulty to post-procedural recovery and management. Furthermore, high subdiaphragmatic lesions become challenging in this setting due to issues relating to sedation and compliance with breath hold/breathing instructions. Although general anesthesia may mitigate these complications, the added resources associated with providing general anesthesia during ablation is not cost effective and may result in substantial delays in treatment. The reduction of Aerosol Generating Medical Procedures (AGMP), such as intubation due to the COVID-19 Pandemic, must also be taken into consideration. Due to the potential increased risk of infection transmission, alternatives to general anesthesia should be considered when safe and possible. Upper abdominal regional nerve block techniques have been used to manage pain related to trauma, surgery, and cancer; however, blocks of this nature are not well described in the interventional radiology literature. The McGill University group has developed experience in using such blocks as splanchnic, celiac and hepatic hilar nerve blocks to provide peri-procedural pain control [1]. Since incorporating these techniques (along with hydrodissection with tumescent anesthesia), we have also observed in our high volume ablation center a dramatic decrease in the amount of sedatives administered during the procedure, a decrease in patient discomfort during localization and ablation, as well as decreased pain post-procedure. Faster time to discharge and overall reduction in room procedural time serve as added benefits. The purpose of this publication is to outline and illustrate the practical application and use of nerve block/regional anesthesia techniques with respect to percutaneous hepatic thermal ablation.

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Ultrasound-guided phrenic nerve block for intraoperative persistent hiccups: a case report

Cited by 20 publications

References 12 publications

Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview

Regional Anesthesia to the Rescue: Phrenic Nerve Block to Prevent Wound Dehiscence From Intractable Hiccups—A Case Report

Optimized nerve block techniques while performing percutaneous hepatic ablation: Literature review and practical use

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