Bilateral Phrenic Nerve Block For the Treatment of Intractable Hiccup in a Palliative Care Patient: A Case Report

Abstract

Hiccup is the characteristic voice caused by the sudden closure of the glottis during the contraction of the muscles of respiration especially diaphragm. It usually ends spontaneously in a short time. If it lasts more than one month, it is called as intractable hiccup. Intractable hiccups may lead to malnutrition, hypoxia, arrhythmia, dehydration, depression, tiredness and sleep disorder. Those can affect the quality of life of the patient. It is reported that pharmacologic agents such as gamma-aminobutyric acid receptor agonists, dopamine antagonists, antipsychotics and baclofen may he beneficial in the treatment of intractable hiccups. If success is not achieved with these methods, invasive methods such as phrenic nerve block, regional anesthesia, and phrenic nerve pulse radiofrequency may he applied as alternative therapies. In this case report, it is aimed to present the medical management of a palliative care patient with intractable hiccup. A 55-year-old male patient underwent gastrectomy and distal csophagectomy due to esophagogastric junction tumor. He suffered from intractable hiccup after esophageal hematoma. Bilateral phrenic nerve block was performed; hence no recovery was achieved after five weeks of medical treatment. Most of his complaint about hiccup was recovered after phrenic nerve block.