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Singh H, Rajarathinam M. Stellate ganglion block beyond chronic pain: A literature review on its application in painful and non-painful conditions. J Anaesthesiol Clin Pharmacol 2024; 40:185-191. [PMID: 38919437 PMCID: PMC11196062 DOI: 10.4103/joacp.joacp_304_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 06/27/2024] Open
Abstract
Cervical sympathetic or stellate ganglion blocks (SGBs) have been commonly used in the treatment of painful conditions like complex regional pain syndrome (CRPS). However, there is literature to suggest its utility in managing non-painful conditions as well. The focus of this literature review is to provide an overview of indications for SGB for painful and non-painful conditions. We identified published journal articles in the past 25 years from Embase and PubMed databases with the keywords "cervical sympathetic block, stellate ganglion blocks, cervical sympathetic chain, and cervical sympathetic trunk". A total of 1556 articles were obtained from a literature search among which 311 articles were reviewed. Among painful conditions, there is a lack of evidence in favor of or against the use of SGB for CRPS despite its common use. SGB can provide postoperative analgesia in selective surgeries and can be effective in temporary pain control of refractory angina and the acute phase of herpes zoster infection. Among non-painful conditions, SGB may have beneficial effects on the management of post-traumatic stress disorder (PTSD), refractory ventricular arrhythmias, hot flashes in postmenopausal women, and breast cancer-related lymphedema. Additionally, there have been various case reports illustrating the benefits of SGB in the management of cerebral vasospasm, upper limb erythromelalgia, thalamic and central post-stroke pain, palmar hyperhidrosis, orofacial pain, etc. In our review of literature, we found that SGB can be useful in the management of various non-painful conditions beyond the well-known treatment for CRPS, although further studies are required to prove its efficacy.
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Affiliation(s)
- Heena Singh
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesia and Perioperative Medicine, Western University, London, Ontario, Canada
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McDonnell TJ, Waldron D, Collins C, Kennedy G, Murphy D, Lannon C, Flynn C, Levins KJ, Donnellan P. Complex symptom control with early integrated palliative medicine for a primary mediastinal mass. BMJ Support Palliat Care 2024; 13:e977-e980. [PMID: 37402539 DOI: 10.1136/spcare-2022-003966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 06/14/2023] [Indexed: 07/06/2023]
Affiliation(s)
| | - Dympna Waldron
- Palliative Medicine, Galway University Hospitals, Galway, Ireland
- National University of Ireland Galway, Galway, Ireland
| | - Chris Collins
- Upper GI, General & Bariatric Surgery, Galway University Hospitals, Galway, Ireland
| | - Grace Kennedy
- Palliative Care, Galway University Hospitals, Galway, Ireland
| | - David Murphy
- Palliative Care, Galway University Hospitals, Galway, Ireland
| | - Cian Lannon
- Palliative Care, Galway University Hospitals, Galway, Ireland
| | - Calvin Flynn
- Medicine, Galway University Hospitals, Galway, Ireland
| | - Kirk J Levins
- Department of Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
- Department of Clinical Medicine, University College Dublin, Dublin, Ireland
| | - Paul Donnellan
- Medical Oncology, Galway University Hospitals, Galway, Ireland
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Recio SZ, Abdennadher M. Intractable hiccups after VNS implantation: a case report. BMC Neurol 2023; 23:297. [PMID: 37563736 PMCID: PMC10413770 DOI: 10.1186/s12883-023-03352-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Hiccups (medically termed, "singultus"), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy. CASE PRESENTATION We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient's hiccups persisted and only stopped once the VNS was permanently deactivated. CONCLUSIONS Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.
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Affiliation(s)
- Susan Zhang Recio
- Department of Neurology, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Myriam Abdennadher
- Department of Neurology, Boston Medical Center/Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA.
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Zhong Y, Deng J, Wang L, Zhang Y. Phrenic nerve block combined with stellate ganglion block for postoperative intractable hiccups: a case report. J Int Med Res 2023; 51:3000605231197069. [PMID: 37666219 PMCID: PMC10478533 DOI: 10.1177/03000605231197069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
Postoperative intractable hiccups slow patient recovery and generate multiple adverse effects, highlighting the importance of investigating the pathogenesis and terminating the hiccups in a timely manner. At present, medical and physical therapies account for the main treatments. We encountered a case in which postoperative intractable hiccups after biliary T-tube drainage removal ceased with the application of an ultrasound-guided block of the unilateral phrenic nerve and stellate ganglion. No complications developed, and the therapeutic effect was remarkable. To our knowledge, this approach has not been reported to date. Simultaneously blocking the phrenic nerve and stellate ganglion may be a treatment option for intractable hiccups.
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Affiliation(s)
- Yubin Zhong
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou, China
| | - Jingjing Deng
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou, China
| | - Liyu Wang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou, China
| | - Yuenong Zhang
- Department of Surgery and Anesthesia, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou, China
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Shivkumar V, Nemade D, Dhingra N. Persistent hiccups following thalamic hemorrhage: A case report. Heliyon 2023; 9:e16409. [PMID: 37274664 PMCID: PMC10238684 DOI: 10.1016/j.heliyon.2023.e16409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 06/06/2023] Open
Abstract
Persistent hiccups (lasting more than 48 hours) can cause physical and emotional distress. They can result in dehydration, exhaustion, malnutrition, insomnia, wound dehiscence, ventilatory desynchronization, and hemodynamic changes. Hiccups are thought to be due to a complex reflex arc involving peripheral nerves and central structures such as the brainstem, temporal lobe, basal ganglia, hypothalamus, and spinal cord levels C3-5. Medullary strokes, for instance, have been reported to cause hiccups. We report a patient with a thalamic bleed who developed persistent hiccups. A 56-year-old man was brought to the hospital in an unresponsive state. He was intubated for airway protection. CT brain showed a left thalamic hemorrhage with edema and mass effect on the 3rd ventricle, intraventricular extension of hemorrhage, and hydrocephalus. An external ventricular drain was placed successfully with adequate drainage. One week after admission, the patient developed persistent abdominal jerks. These jerks were occurring every 3-4 seconds and would last for hours with brief periods of remission. He was started on levetiracetam 1000 mg IV bid and then increased to 1500 mg IV BID without any improvement of symptoms. The patient was also placed on EEG which did not reveal any epileptiform abnormality but did show an EMG artifact. His electrolytes including sodium, and potassium, and corrected calcium levels were normal. He did not have any evidence of pneumonia or other infections. It was determined that these jerks were likely hiccups. Metoclopramide 10 mg IV was tried without any benefit. He was then started on Baclofen 10 mg PO TID which resulted in a significant improvement in hiccups. Our case suggests that thalamic lesions might also lead to persistent hiccups.
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Lopez DJ, Kumar S. Stellate Ganglion Block for Intractable Hiccups Secondary to a Motor Vehicle Collision. Cureus 2023; 15:e37030. [PMID: 37143629 PMCID: PMC10153017 DOI: 10.7759/cureus.37030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2023] [Indexed: 05/06/2023] Open
Abstract
Intractable repetitive hiccups are a rare prolongation of the common physiologic reflex arc. If left untreated, chronic hiccups can decrease a patient's quality of life. Many nonpharmacologic, pharmacologic, and interventional treatment modalities have emerged. A 53-year-old male with a past medical history of a motor vehicle collision (MVC) two years earlier presented to a pain clinic with hiccups lasting several months. The patient was experiencing weight loss, lack of sleep, mood changes, and aspiration pneumonia requiring hospitalization secondary to the hiccups. Vagal and respiratory maneuvers and multiple prescription drugs failed to offer hiccup cessation. An ultrasound-guided stellate ganglion block offered immediate, prolonged cessation of the hiccups. When nonpharmacologic and pharmacologic therapies fail to offer improvement of hiccups, as in our patient's case, a stellate ganglion (SG) block may be a viable treatment option for medically refractory cases.
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Affiliation(s)
- Daniel J Lopez
- Department of Pain Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Sanjeev Kumar
- Department of Pain Medicine, University of Florida College of Medicine, Gainesville, USA
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Imaizumi U, Beppu S, Sanuki T. Treatment of unexplained facial numbness with stellate ganglion blockade: A case report. Clin Case Rep 2023; 11:e6871. [PMID: 36698517 PMCID: PMC9850849 DOI: 10.1002/ccr3.6871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/25/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023] Open
Abstract
To date, there is no established treatment for facial numbness or dysesthesia of unspecified causes. Herein, we report a case of unexplained facial numbness and confirmed hypesthesia that achieved clinical response to stellate ganglion blockade (SGB). SGB might be an effective treatment of psychological stress-related facial numbness of unknown origin.
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Affiliation(s)
- Uno Imaizumi
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Satoshi Beppu
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Takuro Sanuki
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
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Zhang Z, Yang X, Ling L, Zhou M. A typically progressive dissection of the internal carotid artery with recurrent hiccups: A case report with continuous 2-year data recording. IBRAIN 2022; 9:124-129. [PMID: 37786522 PMCID: PMC10529161 DOI: 10.1002/ibra.12074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 10/04/2023]
Abstract
Patients with internal carotid artery dissection (ICAD) usually report headache, neck pain, Horner's syndrome, and ischemic stroke. Because the posterior cranial nerve is involved, some patients may show different forms of posterior cranial nerve paralysis. There have been no reports of patients with ICAD showing repeated hiccups. Here, to help clinicians identify ICAD early and gain a better understanding of the atypical manifestations of the disease, we report an atypical case of recurrent hiccup symptoms caused by ICAD.
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Affiliation(s)
- Zong‐Min Zhang
- Department of GeriatricsAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Xin‐Xin Yang
- Department of Anesthesiology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Li Ling
- Department of GeriatricsAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
| | - Man‐Hong Zhou
- Department of EmergencyKweiChow Moutai HospitalRenhuaiGuizhouChina
- Department of emergencyAffiliated Hospital of Zunyi Medical UniversityZunyiGuizhouChina
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Tariq K, Das JM, Monaghan S, Miserocchi A, McEvoy A. A case report of Vagus nerve stimulation for intractable hiccups. Int J Surg Case Rep 2020; 78:219-222. [PMID: 33360634 PMCID: PMC7773651 DOI: 10.1016/j.ijscr.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022] Open
Abstract
Intractable hiccups are associated with significant morbidity and may lead to mortality. Several medical, pharmacological, surgical and novel treatment options are available. Vagus nerve stimulator placement is a novel surgical option for the treatment of intractable hiccups. Vagus nerve stimulator is currently not approved for the indication of intractable hiccups.
Introduction Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines. Presentation of the case An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion. Discussion A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups. Conclusion VNS insertion is a novel surgical option for the treatment of intractable hiccups.
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Affiliation(s)
- Kanza Tariq
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK.
| | - Joe M Das
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Sasha Monaghan
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Anna Miserocchi
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
| | - Andrew McEvoy
- National Hospital for Neurology and Neurosurgery, Queen's Square, London, UK
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Reichenbach ZW, Piech GM, Malik Z. Chronic Hiccups. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:43-59. [PMID: 31974814 DOI: 10.1007/s11938-020-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. RECENT FINDINGS Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. SUMMARY We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gregory M Piech
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
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Mathew J, Shen S, Liu H. Intraoperative Laryngeal Mask Airway-Related Hiccup: An Overview. ACTA ACUST UNITED AC 2019; 7:145-151. [PMID: 33869664 PMCID: PMC8048698 DOI: 10.31480/2330-4871/103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Hiccup is an involuntary contraction of the diaphragm and intercostal muscles resulting in sudden inspiration and closure of the glottis. The presence of hiccup in the perioperative period can be a challenging problem. Sudden movements of the patient from hiccups can interfere preoperative diagnostic procedures, intraoperative hiccup may delay the beginning of surgery, interfere with the surgical process, and affect intraoperative monitoring, and postoperative hiccup may affect would healing and hemodynamic stability. Hiccup can lead to have increased aspiration risk. Hiccup are is an incompletely understood phenomenon with multiple etiologies. Intraoperative hiccup related to laryngeal mask airway placement has been reported, and it presents unique challenges in diagnosis and management. Both pharmacological and non-pharmacological interventions have been utilized with various level of success. All treatment strategies are primarily aimed at interrupting the hiccup reflex arc.
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Affiliation(s)
- Johann Mathew
- Department of Anesthesiology, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA
| | - Shiqian Shen
- Department of Anesthesia, Critical Care & Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Henry Liu
- Department of Anesthesiology, Drexel University College of Medicine, Reading Hospital/Tower Health System, 420 S 5th Avenue, West Reading, PA 19611, USA
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