Reactions 1061 - 23 Jul 2005

★Bupivacaine

First report of hiccups in an elderly patientfollowing epidural administration: case report

A 65-year-old man developed persistent and recurrenthiccups following the epidural administration of bupivacainefor lumbar spinal stenosis, and for perioperative analgesia.

The man received three 11mL epidural injections at the L2-3level containing 0.08% bupivacaine and triamcinolone,approximately 8 weeks apart. After his first two injections hedeveloped leg weakness that resolved approximately 4 hourslater [time to reaction onset not stated]. After his thirdinjection, he developed mild urinary retention [time to reactiononset not stated] which resolved approximately 6 hours later;he also reported that approximately 1 hour after each injection,he developed hiccups that had persisted for 5–7 days.

Approximately 8 weeks after the third injection, the manreceived a fourth injection of triamcinolone alone, withoutrelapse of hiccups, leg weakness or urinary retention. Twomonths later, he received a fifth epidural triamcinoloneinjection, without development of hiccups.

Approximately 1 year later, the man underwent knee-replacement surgery revision, and received 0.25% bupivacaine10mL via a lumbar epidural catheter, in two equal doses, nearthe end of surgery. He also received fentanyl via the catheter.Postoperatively, an infusion of fentanyl and 0.0625%bupivacaine at a rate of 3.5 mL/h was started. Approximately5 hours later, he developed persistent hiccups. Onpostoperative day 3, he reported experiencing hiccups, andthat he had experienced hicupping episodes previously afterepidural injections. The epidural catheter was subsequentlyremoved in preparation for discharge. He declined treatmentfor his hiccups, which resolved 9 days later.

Author comment: "It seems clear in this case thatbupivacaine given epidurally, or its physiologic effects, can beimplicated as the source of the hiccups."McAllister RK, et al. Recurrent persistent hiccups after epidural steroid injectionand analgesia with bupivacaine. Anesthesia and Analgesia 100: 1834-1836, No. 6,Jun 2005 - USA 800975567

» Editorial comment: A search of AdisBase, Medline and theWHO Adverse Drug Reactions database did not reveal anyprevious case reports of hiccups associated with bupivacaine.

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Reactions 23 Jul 2005 No. 10610114-9954/10/1061-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved