• Odonkor Charles Amoatey CA From the Departments of Physical Medicine & Rehabilitation (CAO, BS, KR, AC), and Neurosurgery (AC), Johns Hopkins University School of Medicin, Brittany Smith, Kimberly Rivera, and Akhil Chhatre.
• From the Departments of Physical Medicine & Rehabilitation (CAO, BS, KR, AC), and Neurosurgery (AC), Johns Hopkins University School of Medicine, Baltimore, Maryland.
• Am J Phys Med Rehabil. 2017 Jan 1; 96 (1): e1-e4.

AbstractSingultus 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.

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