A Severe Case of Dexamethasone-Induced Hiccups Associated with Gastrointestinal Upset after Lumbar Epidural Administration

BACKGROUND: Hiccups are a common and often harmless spasm of the diaphragm and respiratory organs. Hiccups typically resolve spontaneously and without need for medical intervention. However, there have been rare reported instances where hiccups could be present as an adverse effect of dexamethasone, causing drastic and intolerable effects for a prolonged period of time. CASE REPORT: A 59-year-old Caucasian man came to the pain management clinic and was given an epidural, which consisted of 10 mg dexamethasone and 1 mL bupivacaine. Hours later, the patient began having severe hiccups. The hiccups caused severe abdominal pain, disabled him from eating and drinking, and prevented him from sleeping. The hiccups lasted for around 18+ hours, having a sporadic resolution on the second day. CONCLUSIONS: Dexamethasone is often mixed with local anesthetics to treat chronic pain. It is worthwhile to highlight the rare incidence of developing severe hiccups as an adverse effect of dexamethasone administration. KEY WORDS: Dexamethasone, epidural, bupivacaine, hiccups