Related Experiment Video
Updated: Jun 8, 2026
07:13
Implantation and Control of Wireless, Battery-free Systems for Peripheral Nerve Interfacing
Published on: October 20, 2021
Ultrasound-guided continuous phrenic nerve block for persistent hiccups
Steven H Renes1, Geert J van Geffen, Harald C Rettig
1Department of Anesthesiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. s.renes@anes.umcn.nl
Regional Anesthesia and Pain Medicine
|September 14, 2010
Summary
Ultrasound-guided phrenic nerve block with a catheter offers a novel approach for persistent hiccups. This technique avoids repeated procedures by allowing continuous local anesthetic infusion, providing sustained relief.
Area of Science:
- Anesthesiology
- Neurology
- Medical Imaging
Background:
- Persistent hiccups often require interventions beyond conservative and pharmacological treatments.
- Phrenic nerve block (PhNB) is an option for refractory hiccups, but may necessitate repeated procedures.
- Ultrasound (US) guidance enhances the precision and safety of nerve blocks.
Observation:
- A 36-year-old male presented with intractable postoperative hiccups.
- Bilateral diaphragmatic ultrasound revealed abnormal right-sided movement.
- Initial PhNB with local anesthetic injection provided temporary relief.
Findings:
- An in-plane, US-guided phrenic nerve block with a catheter was successfully performed on the right side.
- Continuous local anesthetic infusion via the catheter for 24 hours initially resolved hiccups.
- Recurrence of hiccups upon infusion discontinuation led to re-initiation of the infusion, resulting in sustained resolution without adverse effects.
- This approach demonstrated feasibility and efficacy in managing persistent hiccups.
Implications:
- US-guided in-plane PhNB with a catheter is a viable technique for treating persistent hiccups.
- This method potentially avoids the need for repeated phrenic nerve blocks.
- Pre-procedure bilateral diaphragmatic ultrasound is recommended to guide the nerve block placement.
Related Concept Videos
01:19Depolarizing Blockers: Pharmocokinetics
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
01:27Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions
Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
Although all competitive neuromuscular blockers are designed...
Although all competitive neuromuscular blockers are designed...
01:31Skeletal Muscle Relaxants: Therapeutic Uses
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx as...
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
01:28Depolarizing Blockers: Mechanism of Action
Depolarizing blockers act on skeletal muscle fibers' membranes and induce their depolarization. Most depolarizing blockers have two quaternary N+ atoms that bind the nicotinic acetylcholine receptors and cause neuromuscular blockade within minutes.
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...
Succinylcholine is the most commonly used depolarizing blocker. Chemically, it constitutes two molecules of acetylcholine joined together by an acetate methyl group. They act on the receptors in the same way as acetylcholine. Because succinylcholine...