• The Korean Journal of Pain
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• v.10 no.2
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• pp.241-245
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• 1997

Persistent hiccup is defined as duration lasting longer than 48 hours. Reflex arc of hiccup is divided into three parts : afferent, central, efferent. Afferent portion of the neural pathway of hiccup formation is composed of vagus nerve, phrenic nerve, and sympathetic chain arising from T6 to T12. Efferent limb is phrenic nerve. Hiccup center is located in brain stem, midbrain, reticular system and hypothalamus. Persistent hiccup is very difficult to treat by conventional methods. We performed cervical epidural block of the phrenic nerve root for three patients suffering from persistent hiccup. The therapeutic effect was perfect. The mechanism of the cervical epidural block is not yet defined however it is thought to block the efferent nerve fibers and suppress the reflex arc of hiccup. We conclude cervical epidural block is relatively safe and very effective for treating persistent hiccup.

• The Korean Journal of Pain
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• v.8 no.1
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• pp.131-134
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• 1995

Hiccup is characterized by a myoclonus in the diaphragm, resulting in a sudden inspiration associated with an audible closure of the glottis. The reflex arc in hiccups comprises three pars: an afferent, a central and an efferent part. The afferent portion of the neural pathway of hiccup formation is composed of the vagus nerve, the phrenic nerve, and the sympathetic chain arising from T6 to T12. The hiccup center is localised in the brain stem and the efferent limb comprises phrenic pathways. All stimuli affecting the above mentioned reflex arc may produce hiccups. The pathogenesis of persistent hiccups is not known. Hiccup can present a symptom of a subphrenic abscess or gastric distention, and metabolic alterations may also cause hiccups. Numerous treatment modalities have been tried but with questionable success. We describe a patient whose persistant hiccups was treated successfully by a cervical epidural block.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.246-249
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• 1997

Hiccup is defined as an abrupt involuntary contraction of the diaphragm and intercostal muscles with sudden closure of the glottis 35 msec after onset. The term "intractable" is given to those hiccups with a duration ranging from 24 hours to more than 25 years. Short hiccup bouts are mostly associated with gastric distention or alcohol intake, resolved spontaneously or with simple remedies. In contrast, intractable hiccup is a rare but disabling condition which can induce depression, weight loss and sleep deprivation. Although the pathophysiologic mechanisms of hiccup are still poorly understood, wide variety of pathological conditions such as: brain tumor, abdominal tumor, myocardial infarction, renal failure, abdominal surgery etc., can cause intractable hiccup. A 58-year-old male who had suffered from hepatocellular cancer was consulted from medical department due to intractable hiccup. Initial treatment modalities with administrations of metoclopramide and chlorpromazine and nerve block including phrenic nerve block, cervical epidural block and glossopharyngeal nerve block were not effective. Administration of midazolam and baclofen however achieved desirable effect.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.39-43
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• 2008

A hiccup is caused by involuntary, intermittent, and spasmodic contractions of the diaphragm and intercostal muscles. It starts with a sudden inspiration and ends with an abrupt closure of the glottis. Even though a hiccup is thought to develop through the hiccup reflex arc, its exact pathophysiology is still unclear. The etiologies include gastrointestinal disorders, respiratory abnormalities, psychogenic factors, toxic-metabolic disorders, central nervous system dysfunctions and irritation of the vagus and phrenic nerves. Most benign hiccups can be controlled by traditional empirical therapy such as breath holding and swallowing water. However, though rare, a persistent hiccup longer than 48 hours can lead to significant adverse effects including malnutrition, dehydration, insomnia, electrolyte imbalance, and cardiac arrhythmia. An intractable hiccup can sometimes even cause death. We herein describe a patient with non-small cell lung cancer who was severely distressed by a persistent hiccup.