Involuntary diaphragmatic spasms, "hiccups," commonly resolve spontaneously over a few minutes but can occasionally persist, presenting a challenging perioperative problem. Pregabalin is a frequently utilized gabapentinoid in the treatment of neuropathic pain, but its effectiveness for treating hiccups during the perioperative period has not been well established. We present a patient with a 7-year history of intractable hiccups resistant to chlorpromazine, baclofen, gabapentin, and cervical epidural injections presenting for orthopedic surgery. Perioperative and postoperative pregabalin administration significantly reduced the frequency and severity of hiccups. This case demonstrates the potential for pregabalin in the management of refractory hiccups.

Intractable hiccups are an uncommon but clinically significant condition that can lead to sleep disturbance, fatigue, impaired oral intake, and reduced quality of life. The hiccup reflex arc involves complex peripheral and central pathways, with dopaminergic signaling believed to play a modulatory role. In neurologically complex patients, distinguishing medication-related hiccups from structural central nervous system etiologies remains challenging. We present a 94-year-old male with a history of vascular Parkinsonism and multiple comorbidities who was admitted for acute ischemic stroke involving the right frontal, parietal, and temporal lobes and insula. During his subsequent acute inpatient rehabilitation course, he developed new-onset intractable hiccups occurring approximately every 5 seconds and persisting during sleep, resulting in significant functional impairment. Initial management with metoclopramide and proton pump inhibitor therapy was ineffective, and no pulmonary or gastrointestinal etiology was identified. Given concern for a potential medication contribution in the setting of dopaminergic therapy initiated during hospitalization, carbidopa/levodopa was discontinued. Treatment with chlorpromazine led to progressive resolution of symptoms. This case highlights a complex therapeutic and diagnostic dilemma in which acute cerebrovascular injury and dopaminergic therapy may have jointly contributed to the disruption of the hiccup reflex arc. It underscores the importance of considering both central neurologic and pharmacologic etiologies in intractable hiccups and illustrates the potential role of dopamine antagonism in symptom control within a medically and neurologically vulnerable population.

Hiccups, or singultus, are involuntary diaphragmatic contractions followed by the sudden closure of the glottis, resulting in a characteristic sound. These episodes are generally transient but can be classified as acute (lasting < 48 h), persistent (lasting > 48 h), or intractable (lasting > 1 month). While most cases are self-limiting, persistent or intractable hiccups often suggest an underlying organic, psychogenic, or idiopathic cause. Among the potential causes, drug-induced singultus is a significant yet frequently underrecognized etiology. Although generally benign, persistent hiccups can cause substantial discomfort, disrupt sleep, and impair nutritional intake. In severe instances, they may lead to serious complications. Proper management relies on identifying the inciting factor and implementing appropriate therapeutic strategies. A 72-year-old male with a history of chronic right knee osteoarthritis was prescribed tramadol for pain management. Within 10 h of initiating tramadol therapy, the patient developed persistent singultus, characterized by repetitive involuntary diaphragmatic contractions at intervals of 10-15 s. This led to significant discomfort, impairing both his ability to rest and to consume food. Despite attempting non-pharmacological interventions, such as drinking water and controlled respiration, the symptoms persisted. After a comprehensive assessment, tramadol was identified as the probable cause of the singultus. Consequently, the treatment plan was modified by discontinuing tramadol and introducing Baclofen, which resulted in complete symptom resolution. This case emphasizes the potential for tramadol to induce persistent singultus and underscores the importance of considering individual patient susceptibility when evaluating drug-related adverse effects. Tramadol, while widely used for analgesia, can occasionally provoke rare adverse effects, including persistent singultus. The underlying pathophysiological mechanisms remain incompletely understood but may involve central nervous system pathways. Clinicians should exercise caution when prescribing tramadol, closely monitoring for potential adverse reactions to facilitate early identification and prompt intervention, thus minimizing patient discomfort and preventing further complications.

Interventional spine procedures are widely used non-surgical approaches for the management of acute and chronic pain. Although usually considered safe, these procedures may still be associated with temporary and minor complications, including hiccups. In this article, we report a rare case of a 60-year-old male patient with low back pain who developed recurrent hiccups following a lumbar epidural steroid injection. In conclusion, the exact mechanism of hiccups remains unclear, and their relationship with the level of epidural injection or the specific drug mixture used is not well established. As hiccups following epidural injections have been insufficiently documented in the literature, this case aims to highlight hiccups as a potentially under-recognized adverse effect of epidural steroid injections in interventional pain management.

Hiccups (singultus) are generally benign and self-limiting conditions; however, in some patients, they may become persistent and require treatment. Although proton pump inhibitors (PPIs), chlorpromazine, and various centrally acting agents are commonly used, evidence for alternative treatment options remains limited. While PPIs are frequently utilized for hiccups that develop secondary to dyspepsia, there is limited data in the literature to support antihistamines as an effective treatment modality, and clinical data supporting their use are also limited. This case series aimed to evaluate the clinical utility and safety of the combination of intravenous pantoprazole and pheniramine, an H1 antihistamine with anticholinergic properties, in the treatment of persistent hiccups.