Anesth Pain Med.  2018 Apr;13(2):192-196. 10.17085/apm.2018.13.2.192.

Stellate ganglion block for the treatment of intractable hiccups: A case report

• Son HW
• Cho YW
• Kim YU
• Shin YJ

• KMID: 2437428
• DOI: http://doi.org/10.17085/apm.2018.13.2.192

Abstract

Hiccups are an involuntary contraction of the diaphragm that may repeat several times per minute. In general, hiccups are very common, transient, and self-limited. However, if the condition persists longer than days or months, it impacts a patient's quality of life. Pharmacologic and non-pharmacologic methods are used for the treatment of persistent or intractable hiccups. Nerve block and stimulation have been shown to be effective through neural pathway interruption or stimulation of the hiccup reflex arc. Stellate ganglion block (SGB) is an injection of local anesthetic adjacent to a group of nerves in the neck known as the stellate ganglion. The authors report a case of SGB as an effective treatment for a patient with intractable hiccups resulting from right lateral medullary syndrome.

Keyword

Hiccup; Lateral medullary syndrome; Stellate ganglion; Sympathetic nervous system

MeSH Terms

Diaphragm
Hiccup*
Humans
Lateral Medullary Syndrome
Neck
Nerve Block
Neural Pathways
Quality of Life
Reflex
Stellate Ganglion*
Sympathetic Nervous System

Reference

1. Steger M, Schneemann M, Fox M. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther. 2015; 42:1037–50. DOI: 10.1111/apt.13374. PMID: 26307025.

2. Chang FY, Lu CL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil. 2012; 18:123–30. DOI: 10.5056/jnm.2012.18.2.123. PMID: 22523721. PMCID: PMC3325297.

3. Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: to treat hiccups. J Pain Symptom Manage. 2009; 38:460–5. DOI: 10.1016/j.jpainsymman.2008.10.008. PMID: 19735905.

4. Howard RS. Persistent hiccups. BMJ. 1992; 305:1237–8. DOI: 10.1136/bmj.305.6864.1237. PMID: 1477559. PMCID: PMC1883764.

5. Kang KN, Park IK, Suh JH, Leem JG, Shin JW. Ultrasound-guided Pulsed Radiofrequency Lesioning of the Phrenic Nerve in a Patient with Intractable Hiccup. Korean J Pain. 2010; 23:198–201. DOI: 10.3344/kjp.2010.23.3.198. PMID: 20830266. PMCID: PMC2935982.

6. Ge AX, Ryan ME, Giaccone G, Hughes MS, Pavletic SZ. Acupuncture treatment for persistent hiccups in patients with cancer. J Altern Complement Med. 2010; 16:811–6. DOI: 10.1089/acm.2009.0456. PMID: 20575702. PMCID: PMC3035062.

7. Sato S, Asakura N, Endo T, Naito H. Cervical epidural block can relieve postoperative intractable hiccups. Anesthesiology. 1993; 78:1184–6. DOI: 10.1097/00000542-199306000-00026. PMID: 8512115.

8. Keane JR. Hiccups due to central nervous system disease: analysis of 71 inpatients. Can J Neurol Sci. 2010; 37:870–2. DOI: 10.1017/S0317167100051611. PMID: 21059556.

9. Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog. 2010; 57:150–6. DOI: 10.2344/0003-3006-57.4.150. PMID: 21174569. PMCID: PMC3006663.

10. Elias M. Cervical sympathetic and stellate ganglion blocks. Pain Physician. 2000; 3:294–304. PMID: 16906187.

11. Cha DC, Song JH, Song BH, Lee JH, Shinn HK, Lee HS. A SGB treatment case of a patient's postoperative intractable hiccup: a case report. Anesth Pain Med. 2010; 5:277–9.

12. Uchida K, Tateda T, Hino H. Novel mechanism of action hypothesized for stellate ganglion block related to melatonin. Med Hypotheses. 2002; 59:446–9. DOI: 10.1016/S0306-9877(02)00158-5.

13. Mulvaney SW, McLean B, de Leeuw J. The use of stellate ganglion block in the treatment of panic/anxiety symptoms with combat-related post-traumatic stress disorder;preliminary results of long-term follow-up: a case series. Pain Pract. 2010; 10:359–65. DOI: 10.1111/j.1533-2500.2010.00373.x. PMID: 20412504.

14. Lipov EG, Joshi JR, Sanders S, Slavin KV. A unifying theory linking the prolonged efficacy of the stellate ganglion block for the treatment of chronic regional pain syndrome (CRPS), hot flashes, and posttraumatic stress disorder (PTSD). Med Hypotheses. 2009; 72:657–61. DOI: 10.1016/j.mehy.2009.01.009. PMID: 19237252.

15. Glick DB. The autonomic nervous system. Miller's Anesthesia. 8th ed. Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Philadelphia: Churchill Livingstone/Elsevier;2015. p. 346–86.