title: Ultrasound-guided continuous phrenic nerve block for persistent hiccups.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. s.renes@anes.umcn.nl
authors.forename: Steven H
authors.initials: SH
authors.lastname: Renes
authors.forename: Geert J
authors.initials: GJ
authors.lastname: van Geffen
authors.forename: Harald C
authors.initials: HC
authors.lastname: Rettig
authors.forename: Mathieu J
authors.initials: MJ
authors.lastname: Gielen
authors.forename: Gert J
authors.initials: GJ
authors.lastname: Scheffer
mesh_terms: D000328:Adult; D006606:Hiccup / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010791:Phrenic Nerve / Q000000981:diagnostic imaging*; D012008:Recurrence; D018084:Ultrasonography, Interventional