Jevotovsky David S, Suarez Michael, Chopra Harman, Marascalchi Bryan J
NYU Langone Health, New York, New York, USA.
Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Reg Anesth Pain Med. 2024 Aug 5. doi: 10.1136/rapm-2024-105796.
Intractable hiccups, defined as those persisting for over 1 month, represent a rare but significant clinical challenge often associated with substantial morbidity and refractory to standard treatments.
This case report describes the innovative use of phrenic nerve peripheral neuromodulation for managing chronic intractable hiccups in a 73-year-old male patient with a 6-year history of daily hiccups. Conventional treatments and interventional procedures had failed to provide lasting relief. Bilateral phrenic nerve peripheral nerve stimulation (PNS) placed under ultrasound guidance resulted in immediate and substantial improvement, with the patient's Hiccup Assessment Instrument score decreasing from 6/10 to 2/10. The patient experienced significant enhancements in speech and quality of life without complications.
This novel application of phrenic nerve PNS highlights its potential as a therapeutic strategy for intractable hiccups, underscoring their pathophysiologic involvement of the diaphragm and respiratory muscles. The findings suggest that phrenic nerve PNS could offer a viable treatment option for patients unresponsive to conventional therapies, warranting further research to establish its long-term efficacy and safety.
顽固性呃逆定义为持续超过1个月的呃逆，是一种罕见但严重的临床挑战，常伴有较高的发病率且对标准治疗无效。
本病例报告描述了膈神经外周神经调节在一名73岁男性慢性顽固性呃逆患者中的创新应用，该患者有6年每日呃逆病史。传统治疗和介入程序均未能提供持久缓解。在超声引导下进行双侧膈神经外周神经刺激（PNS）后，症状立即得到显著改善，患者的呃逆评估仪器评分从6/10降至2/10。患者的言语和生活质量有显著提高，且无并发症。
膈神经PNS的这种新应用突出了其作为顽固性呃逆治疗策略的潜力，强调了其在膈肌和呼吸肌病理生理过程中的作用。研究结果表明，膈神经PNS可为对传统疗法无反应的患者提供一种可行的治疗选择，值得进一步研究以确定其长期疗效和安全性。
