The annoyance of singultus: a case report of a rare adverse effect after epidural steroid injection

• Published in: BMC anesthesiology Vol. 24; no. 1; pp. 302 - 6
• Main Authors: Mena, Shayla, Raj, Ashneel, Caldwell, William, Kaushal, Amit
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.08.2024; BioMed Central; BMC
• Subjects: Acupuncture; Adverse effect; Algorithms; Antipsychotics; Baclofen; Care and treatment; Case reports; Central nervous system depressants; Cerebrospinal fluid; Chlorpromazine; Chronic pain; Chronic Pain - drug therapy; Complications and side effects; Dexamethasone; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Dopamine; Dyspnea; Epidural; Gabapentin; Gastroesophageal reflux; General contractors; Hiccup - chemically induced; Hiccups; Humans; Injections, Epidural - adverse effects; Interventional pain procedures; Lidocaine; Magnetic resonance imaging; Male; Meningitis; Metoclopramide; Middle Aged; Neck pain; Neck Pain - drug therapy; Pain; Pain management; Physiological aspects; Side effects; Singultus; Spine (cervical); Spine (lumbar); Stenosis; Steroids; Hiccups; Singultus; Interventional pain procedures; Adverse effect; Pain management
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-024-02682-8

Cervical epidural steroid injections (ESIs) can provide effective pain management for patients suffering from chronic neck pain due to various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups ("singultus"). Based on a limited number of cases, we propose a modified treatment algorithm for this adverse outcome (Fig. 3). Singultus has been documented as an adverse effect of interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the case of a general contractor who presented to our clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar ESI in the past and was recommended for a cervical interlaminar ESI. After an uneventful C6-C7 interlaminar ESI with dexamethasone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology. Persistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents, and possible dual or triple therapy if further indicated.