Management of Intractable Hiccups -A report of 3 cases-

Abstract

Hiccups are a common, and self-limiting disorder. However intractable hiccups can lead to multiple problems including exhaustion. Hiccups are due to an intermittent clonic spasm of the diaphragm. The neural pathway concerned has been described as a reflex arc with an afferent limb composed of the vagus nerve, phrenic nerve, and a sympathetic chain arising from T6-T12. The efferent limb is the phrenic nerve. Brainstem centers independent of the respiratory center are thought to be responsible for hiccups. Three intractable hiccup patients were referred to our pain clinic. initially, they were unsuccessfully managed using conservative methods, i.e., breath holding, induced gag reflex, and the oral administration of metoclopramide. We first tried phrenic nerve block and/or interpleural block, and then followed with oral baclofen and amitriptyline. We conclude that phrenic nerve block and interpleural nerve block combined with baclofen and amitriptyline is good treatment method for intractable hiccups.