Remedies for Intractable Hiccups
April 10th, 2007 at 7:56 am by NickLynn was telling me about a case she saw this year – if I recall, it was a young man who developed uncontrollable hiccuping after an inguinal hernia repair. I don’t know what happened to the guy, but I saw my first hiccuping patient shortly thereafter. As I surf the web, I keep coming across remedies for this unusual but vexing complaint:
- Methylcellulose (to expand the stomach)
- NG Tube (to decompress the stomach)
- An implantable vagal nerve stimulator
- Pressing on the ears while drinking through a straw
- Digital rectal massage (also reported in Annals of EM)
- Chlorpromazine 25-50mg IV (the only FDA-approved agent for intractable hiccups)
Our anesthesia colleagues have looked at this issue, as hiccuping in the OR is a pressing concern. Unfortunately, a systematic review (Kranke, Eur J Anaesthesiol 2003 Mar;20(3):239-44) turned up lots of anecdotes, but only one (inconclusive) RCT:
A large variety of interventions have been proposed for the treatment of hiccup during anaesthesia and sedation. However, perioperative treatment is still based on empirical findings and no treatment is ‘evidence-based’. Thus, no valid recommendations for the treatment of hiccup can be derived. Uncontrolled observations are inadequate to establish treatment efficacy.
More drug suggestions below, along with some background on hiccups…
Posted in GI, Procedures, Journal Club | 1 Comment »
