Korean J Pain.  2010 Sep;23(3):198-201. 10.3344/kjp.2010.23.3.198.

Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup

• Kang KN
• Park IK
• Suh JH
• Leem JG
• Shin JW

• KMID: 1767881
• DOI: http://doi.org/10.3344/kjp.2010.23.3.198

Abstract

Persistent and intractable hiccups (with respective durations of more than 48 hours and 1 month) can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. The conventional treatments for hiccups are either non-pharmacological, pharmacological or a nerve block treatment. Pulsed radiofrequency lesioning (PRFL) has been proposed for the modulation of the excited nervous system pathway of pain as a safe and nondestructive treatment method. As placement of the electrode in close proximity to the targeted nerve is very important for the success of PRFL, ultrasound appears to be well suited for this technique. A 74-year-old man suffering from intractable hiccups that had developed after a coronary artery bypass graft and had continued for 7 years was referred to our pain clinic. He had not been treated with conventional methods or medications. We performed PRFL of the phrenic nerve guided by ultrasound and the hiccups disappeared.

Keyword

hiccup; pulsed radiofrequency; ultrasound

MeSH Terms

Aged
Coronary Artery Bypass
Dehydration
Depression
Electrodes
Fatigue
Hiccup
Humans
Malnutrition
Nerve Block
Nervous System
Pain Clinics
Phrenic Nerve
Stress, Psychological
Transplants
Weight Loss

Figure

• 

  Fig. 1 Ultrasound image of needle tip which is adjacent to phrenic nerve for nerve block.

• 

  Fig. 2 Ultrasound image of patient's phrenic nerve and related structures for pulsed radiofrequency lesioning.

Reference

1. Homer JR, Davies JM, Amundsen LB. Persistent hiccups after attempted interscalene brachial plexus block. Reg Anesth Pain Med. 2005; 30:574–576. PMID: 16326344.

2. Cymet TC. Retrospective analysis of hiccups in patients at a community hospital from 1995-2000. J Natl Med Assoc. 2002; 94:480–483. PMID: 12078929.

3. Pooran N, Lee D, Sideridis K. Protracted hiccups due to severe erosive esophagitis: a case series. J Clin Gastroenterol. 2006; 40:183–185. PMID: 16633116.

4. Cosman ER Jr, Cosman ER Sr. Electric and thermal field effects in tissue around radiofrequency electrodes. Pain Med. 2005; 6:405–424. PMID: 16336478.

5. Nguyen M, Wilkes D. Pulsed radiofrequency V2 treatment and intranasal sphenopalatine ganglion block: a combination therapy for atypical trigeminal neuralgia. Pain Pract. 2010; 10:370–374. PMID: 20492576.

6. Brull R, Perlas A, Cheng PH, Chan VW. Minimizing the risk of intravascular injection during ultrasound-guided peripheral nerve blockade. Anesthesiology. 2008; 109:1142. PMID: 19034116.

7. McFarling DA, Susac JO. Hoquet diabolique: intractable hiccups as a manifestation of multiple sclerosis. Neurology. 1979; 29:797–801. PMID: 221856.

8. Marshall JB, Landreneau RJ, Beyer KL. Hiccups: esophageal manometric features and relationship to gastroesophageal reflux. Am J Gastroenterol. 1990; 85:1172–1175. PMID: 2389728.

9. Kahrilas PJ, Shi G. Why do we hiccup? Gut. 1997; 41:712–713. PMID: 9414986.

10. Lee JH, Kim TY, Lee HW, Choi YS, Moon SY, Cheong YK. Treatment of intractable hiccups with an oral agent monotherapy of baclofen: a case report. Korean J Pain. 2010; 23:42–45. PMID: 20552072.

11. Tegeler ML, Baumrucker SJ. Gabapentin for intractable hiccups in palliative care. Am J Hosp Palliat Care. 2008; 25:52–54. PMID: 18292481.

12. Babacan A, Oztürk E, Kaya K. Relief of chronic refractory hiccups with glossopharyngeal nerve block. Anesth Analg. 1998; 87:980. PMID: 9768811.

13. Calvo E, Fernández-La Torre F, Brugarolas A. Cervical phrenic nerve block for intractable hiccups in cancer patients. J Natl Cancer Inst. 2002; 94:1175–1176. PMID: 12165648.

14. Chou CL, Chen CA, Lin SH, Huang HH. Baclofen-induced neurotoxicity in chronic renal failure patients with intractable hiccups. South Med J. 2006; 99:1308–1309. PMID: 17195438.

15. Canella C, Demondion X, Delebarre A, Moraux A, Cotten H, Cotton A. Anatomical study of phrenic nerve using ultrasound. Eur Radiol. 2010; 20:659–665. PMID: 19727747.

16. Cahana A, Vutskits L, Muller D. Acute differential modulation of synaptic transmission and cell survival during exposure to pulsed and continuous radiofrequency energy. J Pain. 2003; 4:197–202. PMID: 14622704.

17. Philip CN, Candido KD, Joseph NJ, Crystal GJ. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician. 2009; 12:881–885. PMID: 19787014.

18. Liliang PC, Lu K, Liang CL, Tsai YD, Hsieh CH, Chen HJ. Pulsed radiofrequency lesioning of the suprascapular nerve for chronic shoulder pain: a preliminary report. Pain Med. 2009; 10:70–75. PMID: 19222771.