目的:颈椎硬膜外类固醇注射(ESI)可以为颈椎各种病理变化引起的慢性颈痛患者提供有效的疼痛管理。有几个罕见的不良反应报告从介入疼痛程序,包括持续性打嗝(\"singultus\")。根据数量有限的案件,我们针对这种不良结果提出了一种改进的治疗算法(图。3).
方法:单发已被证明是介入疼痛治疗的不良反应,包括硬膜外类固醇,面关节,和骶髂关节注射.我们描述了一名总承包商因慢性颈部疼痛和中央管狭窄而向我们的诊所就诊的情况。该患者过去接受了无并发症的腰椎ESI,并建议进行颈椎层间ESI。在使用地塞米松进行平稳的C6-C7层间ESI之后,1%利多卡因,和生理盐水,患者出现单发。巴氯芬被送到他的药房,但这并不能缓解他的打嗝。患者随后开始服用氯丙嗪,症状缓解。
结论:ESI或介入性疼痛手术后的持续打嗝可以通过保守措施和非药物方法治疗,随着巴氯芬治疗的升级,加巴喷丁,普瑞巴林,甲氧氯普胺,氯丙嗪,其他抗精神病药或抗多巴胺能药物,和可能的双重或三联疗法,如果进一步指示。
OBJECTIVE: Cervical epidural steroid injections (ESIs) can provide effective pain management for patients suffering from chronic neck pain due to various pathological changes of the cervical spine. There are several rare adverse effects reported from interventional pain procedures, including persistent hiccups (\"singultus\"). Based on a limited number of cases, we propose a modified treatment algorithm for this adverse outcome (Fig. 3).
METHODS: Singultus has been documented as an adverse effect of interventional pain procedures, including epidural steroid, facet joint, and sacroiliac joint injections. We describe the
case of a general contractor who presented to our clinic with chronic neck pain and central canal stenosis. The patient received an uncomplicated lumbar ESI in the past and was recommended for a cervical interlaminar ESI. After an uneventful C6-C7 interlaminar ESI with dexamethasone, 1% lidocaine, and normal saline the patient developed singultus. Baclofen was sent to his pharmacy, but this was unsuccessful at alleviating his hiccups. The patient was subsequently started on chlorpromazine and found relief from his symptomatology.
CONCLUSIONS: Persistent hiccups after ESI or interventional pain procedures can be treated with conservative measures and non-pharmacologic methods, with escalation to therapy with baclofen, gabapentin, pregabalin, metoclopramide, chlorpromazine, other antipsychotic or antidopaminergic agents, and possible dual or triple therapy if further indicated.