Continuous cervical epidural block

Kim, Jung Eun; Lee, Mi Kyoung; Lee, Dong Kyu; Choi, Sang Sik

doi:10.1097/md.0000000000009444

Cited by 12 publications

(4 citation statements)

References 21 publications

(15 reference statements)

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“…11 Steroids may also potentially lower the threshold for synaptic transmission in the midbrain, triggering hiccups. 19 Noteworthy neurotransmitters in uencing hiccups include GABA, dopamine, and serotonin, whereas epinephrine, norepinephrine, acetylcholine, and histamine play peripheral roles. 21 Refractory hiccups are typically managed progressively, starting with nonpharmacologic approaches, transitioning to pharmacologic therapy, and potentially resorting to invasive methods such as vagus nerve stimulation, peripheral nerve stimulation, or phrenic nerve block.…”

Section: Discussionmentioning

confidence: 99%

Unusual Onset of Singultus As A Rare Result of Epidural Steroid Injection at a Varied Vertebral Level: A Case Report

Mena,

Raj,

Caldwell

et al. 2023

Preprint

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Objective Cervical epidural steroid injections (ESI) can provide effective pain management for patients suffering from chronic neck pain due to degenerative disc disease or various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups (singultus). Based on the limited number of cases with this adverse outcome, we propose a treatment algorithm for singultus after ESI (Fig. 3).Case Report: While rare, singultus has been documented as an adverse effect of various interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the case of a general contractor who presented to clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar epidural steroid injection in the past and was recommended for an interlaminar cervical ESI. After an uneventful C6-C7 ESI with triamcinolone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology.Conclusion Persistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents and possible dual or triple therapy if further indicated.

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Section: Discussionmentioning

confidence: 99%

Unusual Onset of Singultus As A Rare Result of Epidural Steroid Injection at a Varied Vertebral Level: A Case Report

Mena,

Raj,

Caldwell

et al. 2023

Preprint

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“…Solo existe un reporte hasta la fecha que establece el uso de un anestésico local, en concreto la bupivacaína, como causante de hipo (11). Además, de forma paradójica, los anestésicos locales son uno de los tratamientos que se han utilizado con éxito para el tratamiento del hipo persistente refractario (12), por lo que, existiendo otra causa más probable, como sería la administración de betametasona epidural al describirse múltiples reportes de hipo refractario secundario a corticoterapia (5), es razonable mantener en segundo plano esta hipótesis alternativa. De la misma manera, aunque el paciente presenta como antecedente una miocardiopatía dilatada grave, no había presentado en ningún otro momento de su vida un episodio de hipo relevante hasta el momento del intervencionismo ni ha reaparecido la clínica hasta la fecha, por lo que, aunque esta patología podría actuar como predisponente, no la podríamos considerar como la causa más probable del cuadro descrito anteriormente.…”

Section: Discussionunclassified

Hipo persistente tras inyección epidural de betametasona: a propósito de un caso

Vargas-Ursúa¹,

Ramos-Hernández²,

Fernández-Villar³

2021

Rev. Soc. Esp. Dolor.

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La analgesia epidural mediante inyección de corticoides es un procedimiento frecuente en las unidades de dolor. A pesar de ser una técnica con bajo índice de complicaciones, se ha descrito la aparición de hipo persistente tras la intervención. Se presenta como caso clínico el primer episodio publicado en España y sexto en el mundo de hipo persistente por betametasona administrada mediante inyección epidural, acompañado de una recapitulación sobre la definición de esta entidad y su etiología, fisiopatología, manejo e incidencia en pacientes a tratamiento con corticoides orales y epidurales. Debido a la duración, impacto en la calidad de vida y necesidad de tratamiento sintomático, se considera el caso más grave publicado hasta la fecha.

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“…Intractable hiccups can cause severe discomfort, depression, disability, and in the most extreme cases, it can lead to severe medical problems, including sleep deprivation, respiratory muscle fatigue, nutritional depletion, aspiration pneumonia, and can be fatal. 1 Despite being observed for centuries, the exact pathogenesis of hiccups remains a mystery. A phylogenetic hypothesis for its origin suggests that the ventilator central pattern generator of lower vertebrates (e.g.…”

Section: Introductionmentioning

confidence: 99%

Tramadol-induced hiccups: a case–noncase study in the European pharmacovigilance database

García

Lertxundi

Aguirre

2021

Therapeutic Advances in Drug Safety

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Background: Hiccups are usually benign and self-limiting, but can sometimes be persistent. If left untreated, they can provoke severe discomfort, and even death. Hiccups can be idiopathic, organic, psychogenic, and caused by drugs. Although some case reports have suggested a possible association between tramadol and hiccups, to our knowledge, no study has analyzed this possible relationship. The aim of this study was to analyze whether a disproportionate number of cases of hiccups are reported for tramadol in the EudraVigilance database. Methods: A case–noncase study was conducted to assess the association between hiccups and tramadol, calculating reporting odds ratios (RORs) from 1 January 1995 to 11 September 2020. Cases were selected using the preferred term ‘Hiccups’. The noncases used as controls were all other adverse drug reaction reports recorded in EudraVigilance during the same period. Exposure was defined as exposure to tramadol among cases and noncases. To reduce the risk of confounding by indication, the RORs for tramadol compared with other opioids were obtained. Additionally, we performed a confirmatory analysis in the World Health Organization pharmacovigilance database, VigiBase®. Results: There were 3089 cases of hiccups in the 7,213,623 reports. Tramadol was involved in 50 cases. The ROR for tramadol exposure was 3.35 [95% confidence interval (CI) 2.53–4.43]. This association persisted when comparing tramadol with other opioids; ROR: 2.13 (95% CI 1.52–2.99). Disproportionality was also observed in VigiBase®: ROR 1.69 (95% CI 1.47–1.93). Conclusion: Our study confirms, for the first time, a possible signal for a tramadol–hiccups association. Nevertheless, observational analytical studies are needed to confirm these results Plain Language Summary Evaluation of the relationship between the tramadol and the risk of hiccups Introduction: Hiccups are sudden involuntary contractions of the diaphragm. This involuntary contraction causes the vocal cords to close very briefly, which produces the characteristic sound of a hiccup. Hiccups are usually benign and self-limiting, but can sometimes be persistent. If left untreated, they can provoke severe discomfort, depression, disability, and in the most extreme cases, even death. Drugs are a rare cause of hiccups. Methods: This study investigated the possible association between tramadol and hiccups (an unmentioned adverse drug reaction in the Summary of Product Characteristics) in the European pharmacovigilance database (EudraVigilance) and a confirming analysis in the World Health Organization pharmacovigilance database (VigiBase). Results: Our analysis shows that hiccups is relatively more frequently reported in association with tramadol than with other medicinal products, with EudraVigilance and VigiBase confirming this association. Conclusion: Tramadol is an opioid analgesic indicated, alone or in combination with dexketoprofen or paracetamol for pain with various causes, so healthcare professionals and patients should be aware of this possible association.

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Continuous cervical epidural block

Cited by 12 publications

References 21 publications

Unusual Onset of Singultus As A Rare Result of Epidural Steroid Injection at a Varied Vertebral Level: A Case Report

Unusual Onset of Singultus As A Rare Result of Epidural Steroid Injection at a Varied Vertebral Level: A Case Report

Hipo persistente tras inyección epidural de betametasona: a propósito de un caso

Tramadol-induced hiccups: a case–noncase study in the European pharmacovigilance database

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