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      Persistent hiccups following cervical epidural steroid injection with betamethasone

      case-report

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          Abstract

          Singultus (hiccups lasting longer than 48 hours) is a described complication following epidural steroid injections, sacroiliac joint injections, and facet joint injections. The underlying etiology is not completely understood, but it is a condition that can be distressing to patients. Our case presentation involves a 62-year-old male presenting for cervical epidural steroid injection. He subsequently developed persistent hiccups that resolved after medical therapy. When approaching these patients, it is critical to evaluate for potentially life-threatening etiologies before progressing down a treatment algorithm.

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          Systemic review: the pathogenesis and pharmacological treatment of hiccups.

          M. Steger, M Schneemann, M. Fox (2015)
          Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable hiccups that continue for days or months are rare, but can be distressing and difficult to treat.
          Article 0 comments Cited 80 times – based on 0 reviews     Review now
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            Chronic Hiccups: An Underestimated Problem.

            Eva Kohse, Markus W Hollmann, Hubert J. Bardenheuer … (2017)
            Persistent singultus, hiccupping that lasts for longer than 48 hours, can have a tremendous impact on a patient's quality of life. Although involved neurologic structures have been identified, the function of hiccups remains unclear-they have been controversially interpreted as a primitive reflex preventing extent swallowing of amniotic fluid in utero, an archaic gill ventilation pattern, or a fetus' preparation for independent breathing. Persistent singultus often presents as a symptom for various diseases, most commonly illnesses of the central nervous system or gastrointestinal tract; they can also be evoked by a variety of pharmacological agents. It is often impossible to define a singular cause. A wide range of treatment attempts, pharmacological and nonpharmacological, have been concerted to this date; however, chlorpromazine remains the only Food and Drug Administration-approved drug in this context. Large-scale studies on efficacy and tolerance of other therapeutic strategies are lacking. Gabapentin, baclofen, and metoclopramide have been reported to accomplish promising results in reports on the therapy of persistent singultus; they may also be effective when given in combination with other drugs, eg, proton pump inhibitors, or as conjoined therapy. As another approach of note, acupuncture treatment was able to abolish hiccups in a number of studies. When managing hiccup patients within the clinical routine, it is of importance to conduct a comprehensive and effective diagnostic workup; a well-functioning interdisciplinary team is needed to address possible causes for the symptom. Persistent singultus is a medical problem not to be underestimated; more research on options for effective treatment would be greatly needed.
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              Persistent hiccups after interventional pain procedures: a case series and review.

              Arjang Abbasi, Christine M Roque-Dang, Gautam K Malhotra (2012)
              Interventional spine procedures are nonsurgical interventions that are commonly used to treat acute and chronic pain. These procedures generally are considered to be safe, but patients may experience transient and minor complications. Hiccups previously have been reported in the pain management setting as a complication after lumbar and thoracic epidural steroid injections and an intrathecal morphine pump infusion. In this case series of 8 patients, we describe hiccups after various interventional procedures, including cervical and lumbar epidural steroid injections, facet joint injections, and sacroiliac joint injections. A comprehensive literature review of hiccups associated with interventional pain procedures is provided, along with the known pathophysiology, etiologies, and treatment options for hiccups. The objective of this case series presentation and literature review is to highlight the importance of recognizing hiccups as a potentially under-reported adverse reaction in the setting of various interventional spine procedures.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int Med Case Rep J
                Journal ID (iso-abbrev): Int Med Case Rep J
                Journal ID (publisher-id): International Medical Case Reports Journal
                Title: International Medical Case Reports Journal
                Publisher: Dove Medical Press
                ISSN (Electronic): 1179-142X
                Publication date Collection: 2018
                Publication date (Electronic): 11 October 2018
                Volume: 11
                Pages: 263-264
                Affiliations
                Department of Anesthesiology, Mayo Clinic Hospital, Phoenix, AZ, USA, ritz.matthew@ 123456mayo.edu ; gorlin.andrew@ 123456mayo.edu
                Author notes
                Correspondence: Matthew L Ritz; Andrew Gorlin, Department of Anesthesiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA, Tel +1 480 515 6296, Email ritz.matthew@ 123456mayo.edu ; gorlin.andrew@ 123456mayo.edu
                Article
                Publisher ID: imcrj-11-263
                DOI: 10.2147/IMCRJ.S174014
                PMC ID: 6187975
                PubMed ID: 30349405
                SO-VID: 7aabcd96-782c-44cf-ad05-04d68fc4721e
                Copyright © © 2018 Ritz et al. This work is published and licensed by Dove Medical Press Limited
                License:

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Categories
                Subject: Case Report

                Keywords: singultus,epidural steroid injection,persistent hiccups,betamethasone
                Data availability:
                Keywords: singultus, epidural steroid injection, persistent hiccups, betamethasone

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