Phrenic Nerve Block for Intractable Hiccups: A Case Series

Phrenic nerve block (PhNB) has emerged as a therapeutic option for intractable hiccups, defined as those persisting for more than 30 days. While previous case reports have shown success with this procedure, particularly in post-surgical cases, its efficacy across different patient populations remains uncertain. We present seven cases of intractable hiccups treated with PhNB that demonstrated limited or no therapeutic benefit. The cases include both idiopathic and post-procedural etiologies, with hiccups lasting from four months to 13 years. Patients underwent ultrasound-guided PhNBs using local anesthetic and perineural dexamethasone, with some patients receiving bilateral treatments. Despite initial relief in some cases, the therapeutic effect was either temporary or absent, with one patient experiencing severe post-procedure exacerbation of symptoms. Various alternative treatments were attempted, including peripheral nerve stimulation devices, with varying success. This case series highlights the variable response to PhNB in treating intractable hiccups and emphasizes the need for careful patient selection. It also underscores the importance of developing standardized protocols for anesthetic dosing and procedural techniques, while considering alternative therapeutic approaches for this challenging condition. These cases contribute to the growing body of literature on interventional treatments for intractable hiccups and highlight the complexities in managing this condition.