title: Persistent Singultus Associated with Lumbar Epidural Steroid Injections in a Septuagenarian: A Case Report and Review.
abstract: Singultus are rare but notable adverse effect of epidural steroid injections (ESIs). To date, reports of persistent hiccups associated with ESIs have been reported mostly in adults aged 65 years or older. We present the first case of persistent hiccups in a septuagenarian who underwent repeated transforaminal ESIs for chronic lumbar radiculopathy. Under fluoroscopic guidance, 1.5 mL of 1% lidocaine (preservative free) and 0.8 mL of dexamethasone solution (10 mg/mL) was injected into the bilateral L4-L5 neural foramen and epidural space.After the first epidural injection, episodes of singultus occurred at a frequency of 5 to 7 episodes per minute and lasted for 36 hours. One month later, he was treated with the second epidural injection after which he immediately developed singultus, occurring at 2- to 3-hour intervals. Interventions for the singultus included drinking small sips of water, vagal maneuvers, and oropharyngeal stimulation with ice chips. The singultus eventually resolved without medical intervention within 5 days of onset. A major take-home point is that preprocedure informed consent should include singultus as one of the potential adverse effects of ESIs. Increased awareness and appropriate planning may help curb the incidence of adverse outcomes in older adults undergoing ESI.
authors.affiliation: From the Departments of Physical Medicine & Rehabilitation (CAO, BS, KR, AC), and Neurosurgery (AC), Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Charles Amoatey
authors.initials: CA
authors.lastname: Odonkor
authors.forename: Brittany
authors.initials: B
authors.lastname: Smith
authors.forename: Kimberly
authors.initials: K
authors.lastname: Rivera
authors.forename: Akhil
authors.initials: A
authors.lastname: Chhatre
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006606:Hiccup / Q000209:etiology*; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D017116:Low Back Pain / Q000188:drug therapy; D008159:Lumbar Vertebrae; D008297:Male; D012075:Remission, Spontaneous; D013130:Spinal Stenosis / Q000188:drug therapy
chemical_list: D000779:Anesthetics, Local; D005938:Glucocorticoids; D003907:Dexamethasone; D008012:Lidocaine