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2018 ; 97
(6
): e9444
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Continuous cervical epidural block: Treatment for intractable hiccups
#MMPMID29419660
Kim JE
; Lee MK
; Lee DK
; Choi SS
; Park JS
Medicine (Baltimore)
2018[Feb]; 97
(6
): e9444
PMID29419660
show ga
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 4?mL/h of
ropivacaine was administered through the epidural catheter using an infuser
containing 0.75% ropivacaine (45?mL ropivacaine and 230?mL normal saline). When
the hiccups stopped and did not recur for 48?hours, 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.