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Successful termination of persistent hiccups via combined ultrasound and nerve stimulator-guided singular phrenic nerve block: a case report and literature review.

ABSTRACT: Persistent hiccups that occur after abdominal surgery seriously affect postoperative rehabilitation. Phrenic nerve block therapy has been recommended after failure of medication or physical maneuvers. However, the phrenic nerve is often difficult to accurately identify because of its small diameter and anatomic variations. We combined ultrasound with the use of a nerve stimulator to quickly and accurately identify and block the phrenic nerve in a patient with postoperative persistent hiccups. The ongoing hiccups were immediately terminated with no adverse effects. The patient reported no recurrence during the 2-week follow-up period. We conclude that the combined use of real-time ultrasound guidance and a nerve stimulator for singular phrenic nerve block might be an effective intervention for terminating postoperative persistent hiccups, although further studies are needed to evaluate the safety and efficacy of this technique. The findings in this case suggest a potential clinical application for this technique in managing persistent hiccups, thereby contributing to improved patient care and outcomes.

SUBMITTER: Ke X

PROVIDER: S-EPMC10693799 | biostudies-literature | 2023 Dec

REPOSITORIES: biostudies-literature

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Successful termination of persistent hiccups via combined ultrasound and nerve stimulator-guided singular phrenic nerve block: a case report and literature review.

Ke Xijian X Wu Yinzhu Y Zheng Hua H

The Journal of international medical research 20231201 12

Persistent hiccups that occur after abdominal surgery seriously affect postoperative rehabilitation. Phrenic nerve block therapy has been recommended after failure of medication or physical maneuvers. However, the phrenic nerve is often difficult to accurately identify because of its small diameter and anatomic variations. We combined ultrasound with the use of a nerve stimulator to quickly and accurately identify and block the phrenic nerve in a patient with postoperative persistent hiccups. Th ...[more]

PMID: 38041831

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Project description:Interscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function.This was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block. Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test.The spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p <0.001, Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported.A different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients.German Clinical Trials Register (DRKS number 00009908 , registered 26 January 2016).

Dataset Information

Successful termination of persistent hiccups via combined ultrasound and nerve stimulator-guided singular phrenic nerve block: a case report and literature review.

Publications

Successful termination of persistent hiccups via combined ultrasound and nerve stimulator-guided singular phrenic nerve block: a case report and literature review.

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