Comparison the Effects of Ephedrine and Lidocaine in Treatment of Intraoperative Hiccups in Gynecologic Surgery under Sedation

Document Type : Original Article


Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran


Background: This study aimed to evaluate and compare the therapeutic effects of ephedrine and lidocaine in treatment of intraoperative hiccups in gynecologic surgery under sedation. Materials and Methods: This randomized clinical trial in Isfahan was done on fifty female patients referring to Shahid Beheshti Hospital who needed to have sedation for medical interventions and they afflicted hiccups during surgery or sedation. Patients divided into two groups of 25 randomly assigned to one of the two groups of ephedrine or lidocaine. Ephedrine group received 5 mg/kg of medicine, while the lidocaine group was under treatment with 1 mg/kg lidocaine. Patients were monitored about systolic and diastolic blood pressure, MAP, heart rate, duration of hiccup, frequency of betterment, duration of intervention, and recovery at 15-min intervals of surgery and recovery. Results: Hiccups were resolved in 14 cases (56%) in the lidocaine group, while the improvement of such problem was achieved in 24 cases (96%) in ephedrine group (P < 0.001), so that the two groups did not have any significant difference in terms of the time of onset but the stop time of hiccups (relative to its start time) in the ephedrine group with the mean value of (2.40 ± 1.16) was significantly lower than the lidocaine group with the mean of 19.64 ± 22.76 min (P = 0.014). In addition, no complications were observed in the two groups. Conclusion: Ephedrine has been more successful than lidocaine as a stimulant in controlling hiccups, and it has been able to suppress hiccups in a higher percentage of patients at a shorter time.


Kahrilas PJ, Shi G. Why do we hiccup? Gut 1997;41:712-3.  Back to cited text no. 1
Chang FY, Lu CL. Hiccup: Mystery, nature and treatment. J Neurogastroenterol Motil 2012;18:123-30.  Back to cited text no. 2
Kolodzik PW, Eilers MA. Hiccups (singultus): Review and approach to management. Ann Emerg Med 1991;20:565-73.  Back to cited text no. 3
Woelk CJ. Managing hiccups. Can Fam Physician 2011;57:672-5, e198-201.  Back to cited text no. 4
Smith HS. Hiccups. In: Walsh TD, Caraceni AT, Fainsinger R, Foley KM, Glare P, Goh C, et al., editors. Palliative Medicine. New York: Saunders; 2009. p. 894-8.  Back to cited text no. 5
Regnard C. Dysphagia, dyspepsia and hiccup. In: Doyle D, Hanks G, Cherny NI, Calman K, editors. Oxford Textbook of Palliative Medicine. 4th ed. New York: Oxford University Press; 2010. p. 499-512.  Back to cited text no. 6
Davignon A, Lemieux G, Genest J. Chlorpromazine in the treatment of stubborn hiccup. Union Med Can 1955;84:282-4.  Back to cited text no. 7
Friedgood CE, Ripstein CB. Chlorpromazine (thorazine) in the treatment of intractable hiccups. J Am Med Assoc 1955;157:309-10.  Back to cited text no. 8
Petroianu G, Hein G, Petroianu A, Bergler W, Rüfer R. Idiopathic chronic hiccup: Combination therapy with cisapride, omeprazole, and baclofen. Clin Ther 1997;19:1031-8.  Back to cited text no. 9
Petroianu G, Hein G, Petroianu A, Bergler W, Rüfer R. ETICS study: Empirical therapy of idiopathic chronic singultus. Z Gastroenterol 1998;36:559-66.  Back to cited text no. 10
Chou CL, Chen CA, Lin SH, Huang HH. Baclofen-induced neurotoxicity in chronic renal failure patients with intractable hiccups. South Med J 2006;99:1308-9.  Back to cited text no. 11
Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013;1:CD008768.  Back to cited text no. 12
Wang T, Wang D. Metoclopramide for patients with intractable hiccups: A multicentre, randomised, controlled pilot study. Intern Med J 2014;44:1205-9.  Back to cited text no. 13
Zhang C, Zhang R, Zhang S, Xu M, Zhang S. Baclofen for stroke patients with persistent hiccups: A randomized, double-blind, placebo-controlled trial. Trials 2014;15:295.  Back to cited text no. 14
Wilcox SK, Garry A, Johnson MJ. Novel use of amantadine: To treat hiccups. J Pain Symptom Manage 2009;38:460-5.  Back to cited text no. 15
Renes SH, van Geffen GJ, Rettig HC, Gielen MJ, Scheffer GJ. Ultrasound-guided continuous phrenic nerve block for persistent hiccups. Reg Anesth Pain Med 2010;35:455-7.  Back to cited text no. 16
Boulouffe C, Vanpee D. Severe hiccups and intravenous lidocaine. Acta Clin Belg 2007;62:123-5.  Back to cited text no. 17
Becker DE. Nausea, vomiting, and hiccups: A review of mechanisms and treatment. Anesth Prog 2010;57:150-6.  Back to cited text no. 18
Oshima T, Sakamoto M, Arita H. Hiccuplike response elicited by mechanical stimulation of dorsal epipharynx of cats. J Appl Physiol (1985) 1994;76:1888-95.  Back to cited text no. 19
Lee JH, Kim TY, Lee HW, Choi YS, Moon SY, Cheong YK, et al. Treatment of intractable hiccups with an oral agent monotherapy of baclofen -a case report-. Korean J Pain 2010;23:42-5.  Back to cited text no. 20
Neuhaus T, Ko YD, Stier S. Successful treatment of intractable hiccups by oral application of lidocaine. Support Care Cancer 2012;20:3009-11.  Back to cited text no. 21
Jeon YS, Kearney AM, Baker PG. Management of hiccups in palliative care patients. BMJ Support Palliat Care 2018;8:1-6.  Back to cited text no. 22
Kaneishi K, Kawabata M. Continuous subcutaneous infusion of lidocaine for persistent hiccup in advanced cancer. Palliat Med 2013;27:284-5.  Back to cited text no. 23
Cohen SP, Lubin E, Stojanovic M. Intravenous lidocaine in the treatment of hiccup. South Med J 2001;94:1124-5.  Back to cited text no. 24
Koteswara CM, Dubey JK. Management of laryngeal mask airway induced hiccups using dexmedetomedine. Indian J Anaesth 2013;57:85.  Back to cited text no. 25
[PUBMED]  [Full text]  
Nwagwu CC, Ebirim LN. Postoperative hiccup induced by LMA – A case report with literature review. Open J Anesthesiol 2014;4:236.  Back to cited text no. 26
Landers C, Turner D, Makin C, Zaglul H, Brown R. Propofol associated hiccups and treatment with lidocaine. Anesth Analg 2008;107:1757-8.  Back to cited text no. 27