Treatment of persistent postoperative hiccups with stellate ganglion block

Abstract

Rationale:Although persistent postoperative hiccups can cause various problems (such as sleep disorders, depression, fatigue) for the patient, there has been little research on this topic. The purpose of this study is to determine the effectiveness of treating persistent postoperative hiccups with a stellate ganglion block (SGB), an injection of local anesthetic in the sympathetic nerve tissue of the neck.Patient concerns and diagnoses:Three patients each developed persistent hiccups within 3 days of abdominal surgery, lasting for 3 to 6 days. The patients were diagnosed as having persistent hiccups based on the hiccup duration.Interventions and outcomes:The 3 patients were treated with an SGB. After the procedure, the frequency and intensity of hiccups decreased and then the hiccups stopped completely.Conclusion:An SGB is an effective method that can be considered in conjunction with other treatments for persistent hiccups. Clinicians should be mindful of the negative effects that persistent hiccups can exert on patients.

Vagal stimulation in a patient with intractable hiccups

“…Although temporary hiccups are a benign occurrence having no signifi cant impact on the life of a person but intractable hiccups are a serious and debilitating pathology and often lead to dire consequences [1][2][3]7]. The world record of longest hiccups is 69 years with notable people such as Pope Pius XII dying from the ailment [13].…”

“…Non-traditional treatments such as acupuncture, massages and hypnosis are also widely used. Non-pharmacological options such as phrenic nerve blocking, crushing and pacing, percutaneous phrenic nerve stimulation and cervical epidural block have shown limited success due to the occasional presence of an accessory phrenic nerve as well as the bilateral diaphragmatic contraction aetiology of centrally originated hiccups [2,3,7,13].…”

“…The afferent limb is composed of the vagus and phrenic nerves, and the lower sympathetic (T6-12) segments. The efferent pathway is constituted by the phrenic nerve(C3-5) innervating the diaphragm, plexal branches to the scalene muscles(C5-7), recurrent laryngeal nerve to the glottis and the intercostal nerves(T1-11) innervating the intercostal muscles [2,3].…”

A case report of Vagus nerve stimulation for intractable hiccups

“…The afferent limb is composed of the Vagus and phrenic nerves, and the lower sympathetic (T6-12) segments. The efferent pathway is constituted by the phrenic nerve (C3-5) innervating the diaphragm, plexal branches to the scalene muscles (C5-7), recurrent laryngeal nerve to the glottis and the intercostal nerves (T1-11) innervating the intercostal muscles [ 2 , 3 ]. The hiccup central connection is believed to be spinal cord segments rostral to medulla oblongata (C3-5) in the reticular formation in the middle and dorsolateral segment, connecting to the hiccup rhythm centre in the Pre-Botzinger complex, nucleus ambiguous, lateral reticular nucleus, hypothalamus and mesial temporal lobes [ [2] , [3] , [4] , [5] ].…”

“…Although GERD can induce hiccups via the irritation of the Vagus nerve, long standing hiccups in themselves can cause reduction in the oesophageal motility as well as lowering of oesophageal-gastric sphincter pressure thus favouring GERD [ 1 , 6 ]. Hiccups are classified as temporary (<48 h), persistent (48 h-1 month) or intractable (>1 month), depending on their duration [ 3 ]. Intractable hiccups may cause debilitating problems such as insomnia, anorexia, fatigue, exhaustion, weight loss, depression, opening of surgical wounds, development of hernia and haemorrhoids, inability to undergo imaging such as MRI and even death.…”