Authors: Kalava A et al.
Source: Cureus 17(11): e96975, November 16, 2025. DOI: 10.7759/cureus.96975.
Summary:
This case series reviews seven patients with intractable hiccups—symptoms lasting over 30 days—treated with ultrasound-guided phrenic nerve blocks (PhNB). The goal was to interrupt the diaphragmatic efferent pathway and “reset” the reflex arc responsible for persistent hiccups. All patients had already failed conservative and pharmacologic therapy, and the hiccup causes ranged from idiopathic to post-procedural (atrial ablation, steroid injection).
The technical approach involved identifying the phrenic nerve on the anterior scalene muscle and injecting local anesthetic with perineural dexamethasone. Some blocks were unilateral, others bilateral. Across the seven patients, the results were inconsistent: a few experienced temporary or partial improvement, but most had minimal benefit, very short-lived relief, or symptom worsening. Adverse effects were noted, including one severe hiccup flare, one case of right-sided Horner’s syndrome, and several paradoxical exacerbations after initial improvement. One patient had substantial short-term benefit (>50% for several days), but long-term follow-up was limited across the series. Efforts such as peripheral nerve stimulation or stellate ganglion block were attempted in some patients, with similarly inconsistent results.
Overall, the series highlights that although phrenic nerve block is frequently suggested as an interventional option for persistent hiccups, its clinical effectiveness is variable and often disappointing in real-world practice. Patient selection remains challenging, standardized dosing is lacking, and bilateral blocks carry respiratory risks. The authors stress that PhNB should be considered an adjunctive or exploratory option rather than a definitive therapy, and that alternative approaches—including vagus nerve stimulation or stellate ganglion block—may warrant further study.
What You Should Know:
• Phrenic nerve block is not consistently effective for intractable hiccups; responses ranged from brief improvement to symptom worsening.
• Bilateral blocks can increase procedural risk; one patient developed Horner’s syndrome.
• PhNB may “reset” the hiccup reflex arc but is unpredictable and should be used cautiously.
• Standardized dosing, technique, and patient-selection criteria are needed before broader adoption.
• Alternatives such as stellate ganglion block or vagus nerve stimulation may hold promise for truly refractory cases.
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