Persistent hiccups after attempted interscalene brachial plexus block.

ABSTRACT

OBJECTIVE: We describe a case of persistent hiccups after attempted interscalene brachial plexus block. CASE REPORT A 38-year-old man was admitted for arthroscopic repair of a right shoulder injury. An interscalene block was attempted in the preoperative area and combined with general anesthesia for surgery. The procedure lasted 5(1/4) hours. After transfer to the recovery room, the patient complained of severe right shoulder pain and had no discernible sensory or motor block. He was noted to be hiccuping. The patient was discharged home the following morning but returned 2 days later complaining of persistent hiccups since surgery, with associated insomnia and nausea. He was readmitted and given chlorpromazine 50 mg intravenously every 8 hours and metoclopramide 10 mg intravenously every 6 hours. The patient was discharged 4 days later on chlorpromazine 25 mg by mouth every 8 hours and baclofen 5 mg by mouth every 12 hours, with hiccups greatly reduced in both intensity and frequency. Hiccups ceased 1 day after discharge. Eighteen days after surgery, he was off all medication with no return of his hiccups; 1 month later he remains hiccup free. CONCLUSIONS: Persistent hiccups have many postulated causes, including several that are common in the perioperative period, but this is the first time to our knowledge that persistent hiccups have been described in association with attempted interscalene brachial plexus block.