Department of Anesthesiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
Reg Anesth Pain Med. 2010 Sep-Oct;35(5):455-7. doi: 10.1097/aap.0b013e3181e8536f.
Phrenic nerve block can be performed and repeated if necessary for persistent hiccups, when conservative and pharmacological treatment is unsuccessful. We report the first description of an in-plane ultrasound (US)-guided phrenic nerve block (PhNB) with a catheter, after US investigation of the bilateral diaphragm, to treat hiccups while avoiding repeated PhNBs.
A 36-year-old man had persistent postoperative hiccups not responding to conservative and pharmacological treatment. Bilateral diaphragmatic US evaluation showed abnormal right-sided movement. A right-sided in-plane US-guided PhNB with catheter was performed. Injection of local anesthetic stopped the hiccups, and a continuous infusion of local anesthetic was started for 24 hrs. After discontinuation of the infusion, the hiccups recurred. Restart of the continuous infusion of the local anesthetic through the catheter was performed, and after discontinuation 24 hrs later, no further hiccups occurred. No adverse effect occurred.
An US-guided in-plane PhNB with catheter is feasible and avoids repeated PhNB when hiccups reoccur. Ultrasound investigation of the bilateral diaphragm should be performed before performing the nerve block.
如果保守和药物治疗不成功，对于持续的呃逆，可以进行并重复膈神经阻滞，如果需要的话。我们报告首例超声（US）引导的膈神经阻滞（PhNB）联合导管的病例，在 US 检查双侧膈肌后，可治疗呃逆，同时避免重复的 PhNB。
一名 36 岁男性，术后呃逆持续，对保守和药物治疗无反应。双侧膈肌 US 评估显示右侧运动异常。进行右侧平面内 US 引导的膈神经阻滞联合导管。局部麻醉注射停止呃逆，并开始持续输注局部麻醉药 24 小时。停止输注后，呃逆再次发生。通过导管重新开始连续输注局部麻醉药，24 小时后停止，呃逆未再发生。无不良反应发生。
超声引导的膈神经阻滞联合导管是可行的，当呃逆再次发生时，可以避免重复进行 PhNB。进行神经阻滞前，应进行双侧膈肌的 US 检查。
