Volume 29, Issue 164, October 2025

Hiccup as a side effect of epidural injection: A literature review

Maciej Trzciński^1♦, Marta Urszula Marciniak¹, Marta Tortyna¹, Natalia Sioch¹, Julia Krotofil¹, Paula Szarek², Kamil Nieczaj¹, Olga Samsel¹, Julia Sztubińska¹, Julia Urbańska¹, Danuta Borowska¹

¹Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
²Faculty of Medicine and Health Sciences, Collegium Medicum of the University of Zielona Góra, Zielona Góra, Poland

^♦Corresponding author
Maciej Trzciński, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland

ABSTRACT

Epidural injections are invasive procedures for pain management, perioperative anesthesia, and labour analgesia. These procedures are generally safe with minor side effects such as hiccups. Scientists explain the pathophysiology of hiccups by the disruption of hiccups “reflex arc”. However, to this day, it remains incompletely understood. Hiccup, an involuntary spasm of the diaphragm and respiratory organs, where a sudden closure of the glottis results in a gulping sound, may differ from acute, self-limiting to intractable. After our thorough analysis, twenty-three papers met the criteria of this work, where 30 patients reported hiccups as a complication of epidural injections. In most cases, physicians injected steroids with anesthetic agents in mixed injectables. Dexamethasone, betamethasone, bupivacaine, and lidocaine were the most frequent drugs in injections. The onset of hiccups was most often between 6 and 24 hours post-procedure. The duration was most frequently up to 2 days, however, many patients complained about hiccups for longer than that. The majority of the patients were older than 50. Most of the patients were males. If hiccups did not resolve spontaneously, the first line of treatment was mostly physical treatment. When it failed, the most common drug treatments were chlorpromazine, metoclopramide, and baclofen. These drugs are mentioned in unofficial treatment recommendations in the literature; however, physicians often chose to treat patients according to their own beliefs rather than following established treatment schemes. This work implies that hiccups as a direct complication of epidural injections requires more clinical awareness.

Keywords: Hiccups, Singultus, Epidural injection, Epidural space, Intractable hiccups

Medical Science, 2025, 29, e201ms3664

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Published: 05 October 2025