TY - JOUR
T1 - Continuous cervical epidural block
T2 - Treatment for intractable hiccups
AU - Kim, Jung Eun
AU - Lee, Mi Kyoung
AU - Lee, Dong Kyu
AU - Choi, Sang Sik
AU - Park, Jong Sun
N1 - Publisher Copyright:
Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown. This study aimed to evaluate the effectiveness of continuous cervical epidural block in the treatment of intractable hiccups. Records from 28 patients with a history of unsuccessful medical and invasive treatments for hiccups were evaluated. Continuous cervical epidural block was performed with a midline approach at the C7-T1 or T1-T2 intervertebral space with the patient in the prone position. The epidural catheter was advanced through the needle in a cephalad direction to the C3-C5 level. Catheter placement was confirmed using contrast radiography. A 6-mL bolus of 0.25% ropivacaine was injected, and a continuous infusion of 4mL/h of ropivacaine was administered through the epidural catheter using an infuser containing 0.75% ropivacaine (45mL ropivacaine and 230mL normal saline). When the hiccups stopped and did not recur for 48hours, the catheter was removed. Cumulative complete remission rates were 60.71% after the first cervical epidural block, 92.86% after the second, and 100% after the third. One patient complained of dizziness that subsided. No other adverse effects were reported. Continuous C3-C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups.
AB - Intractable hiccups, although rare, may result in severe morbidity, including sleep deprivation, poor food intake, respiratory muscle fatigue, aspiration pneumonia, and death. Despite these potentially fatal complications, the etiology of intractable hiccups and definitive treatment are unknown. This study aimed to evaluate the effectiveness of continuous cervical epidural block in the treatment of intractable hiccups. Records from 28 patients with a history of unsuccessful medical and invasive treatments for hiccups were evaluated. Continuous cervical epidural block was performed with a midline approach at the C7-T1 or T1-T2 intervertebral space with the patient in the prone position. The epidural catheter was advanced through the needle in a cephalad direction to the C3-C5 level. Catheter placement was confirmed using contrast radiography. A 6-mL bolus of 0.25% ropivacaine was injected, and a continuous infusion of 4mL/h of ropivacaine was administered through the epidural catheter using an infuser containing 0.75% ropivacaine (45mL ropivacaine and 230mL normal saline). When the hiccups stopped and did not recur for 48hours, the catheter was removed. Cumulative complete remission rates were 60.71% after the first cervical epidural block, 92.86% after the second, and 100% after the third. One patient complained of dizziness that subsided. No other adverse effects were reported. Continuous C3-C5 level cervical epidural block has a successful remission rate. We suggest that continuous cervical epidural block is an effective treatment for intractable hiccups.
KW - Continuous cervical epidural block
KW - Intractable hiccups
KW - Phrenic nerve
UR - http://www.scopus.com/inward/record.url?scp=85042078315&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000009444
DO - 10.1097/MD.0000000000009444
M3 - Article
C2 - 29419660
AN - SCOPUS:85042078315
SN - 0025-7974
VL - 97
JO - Medicine (United States)
JF - Medicine (United States)
IS - 6
M1 - e9444
ER -