Persistent Opioid-Induced Hiccups: A Case Report

Hiccups, also known as singultus, are involuntary contractions of the diaphragm followed by sudden closure of the vocal cords, producing the characteristic "hic" sound. While hiccups are generally harmless, opioids can sometimes cause persistent and disruptive hiccups. Though rare, opioid-induced hiccups can significantly affect patient comfort, and the precise mechanism of opioid-induced hiccups remains unclear. Understanding how to manage this condition is important for healthcare providers. This report discusses a 22-year-old woman who developed recurrent hiccups following surgery with opioid use. A 22-year-old woman with no significant medical history underwent a breast lumpectomy and bilateral mastopexy. Intraoperatively, she received morphine along with other anesthetic agents. Postoperatively, she was managed with a fentanyl PCA (20 mcg/bolus) over 24 h, receiving a total of 755 mcg, coinciding with frequent hiccup episodes starting on Day 1. After discontinuation of the PCA on Day 2, tramadol 100 mg twice daily was initiated. Although hiccups initially decreased, they persisted intermittently. On Day 5, a car ride led to nausea, vomiting, and a prolonged hiccup episode. Hiccups consistently resolved in the supine position but worsened when upright. The patient had no previous history of GERD or frequent hiccups. This highlights the challenges of managing opioid-induced problems and the need for more research to understand the underlying mechanisms. Opioid-induced hiccups, though rare, can be distressing and difficult to manage. The management of this issue continues to provide challenges, as the effectiveness of pharmacological therapies is limited. Additional investigation is required to comprehend the fundamental mechanisms and formulate more efficacious therapeutic interventions.