Relief of Chronic Refractory Hiccups with Glossopharyngeal Nerve Block

Abstract

To the Editor: A 66-yr-old male patient planned to undergo right cochleosacculotomy for Meniere's disease complained of chronic refractory hiccups that lasted for 8 mo and did not respond to chlorpromazine, metoclopramide, omeprazole, or nifedipine. Because the patient had dilated cardiomyopathy, type II diabetes mellitus, and a permanent transvenous pacemaker, a cardiology consultation recommended that local rather general anesthesia be used. However, when the patient was taken to the operating room, he had hiccups that prevented the surgeons from performing the operation. Initially, nasogastric tube decompression was unsuccessful for the relief of hiccups. We then performed a glossopharyngeal nerve block by injecting 3 mL of 0.5% bupivacaine into each posterior tonsillar pillar. Within minutes, a complete relief of hiccups resulted, allowing surgery to proceed under local anesthesia. Approximately 3.5 h after glossopharyngeal nerve block, hiccups occurred again. We repeated the glossopharyngeal nerve block two times postoperatively, but the relief of hiccups lasted approximately 3 h after each block. Unfortunately, these blocks were not curative. Gallacher and Martin [1] not only were the first to perform and describe this block, but they also showed that this block was curative at the same time in a patient suffering from acute hiccups. In conclusion, we showed that despite the fact that this method was not curative in the patient suffering from chronic hiccups, it maintains a temporary relief of chronic hiccups. Avni Babacan, MD Ertan Ozturk, MD Kadir Kaya, MD The University of Gazi; Faculty of Medicine; Department of Anesthesiology and Reanimation; Ankara, Turkey