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Related Concept Videos

Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

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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...
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Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions01:27

Nondepolarizing (Competitive) Neuromuscular Blockers: Pharmacological Actions

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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...
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Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

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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...
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Depolarizing Blockers: Mechanism of Action01:28

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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...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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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...
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Related Experiment Video

Updated: Jan 7, 2026

Functional and Morphological Assessment of Diaphragm Innervation by Phrenic Motor Neurons
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Phrenic Nerve Block for Intractable Hiccups: A Case Series.

Arun Kalava1, Seema Parikh2, Parker Nguyen2

  • 1Department of Anesthesiology, University of Central Florida College of Medicine, Tampa, USA.

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|December 19, 2025
PubMed
Summary

Phrenic nerve block (PhNB) offers limited benefit for intractable hiccups. This study found variable and often temporary relief, highlighting the need for careful patient selection and alternative treatments.

Keywords:
hiccups managementinterventional pain therapyintractable hiccupsnerve block techniquephrenic nerve blockpost-surgical complicationsultrasound-guided procedures

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Area of Science:

  • Neurology
  • Interventional Pain Management

Background:

  • Intractable hiccups, persisting >30 days, pose a therapeutic challenge.
  • Phrenic nerve block (PhNB) is an emerging treatment, but its efficacy is not well-established across diverse patient groups.

Purpose of the Study:

  • To evaluate the therapeutic benefit of PhNB in a series of patients with intractable hiccups.
  • To analyze the outcomes and identify factors influencing treatment response.

Main Methods:

  • Seven patients with intractable hiccups (idiopathic and post-procedural) underwent ultrasound-guided PhNB.
  • Treatments involved local anesthetic and perineural dexamethasone, with some bilateral procedures.

Main Results:

  • PhNB demonstrated limited or no sustained therapeutic benefit in most cases.
  • Relief was temporary in some patients; one experienced symptom exacerbation.
  • Variable responses were observed across different etiologies and durations of hiccups.

Conclusions:

  • Phrenic nerve block shows variable efficacy for intractable hiccups, necessitating careful patient selection.
  • Standardized protocols and exploration of alternative therapies are crucial for managing this condition.