Resolution of 20-year refractory hiccups with ultrasound-guided phrenic nerve radiofrequency modulation and bilateral stellate ganglion block: a case report

Chronic refractory hiccups significantly impair quality of life, especially with prolonged symptom duration. This case highlights the therapeutic potential of a combined interventional approach in managing chronic refractory hiccups, particularly in patients with prolonged symptom duration unresponsive to conventional treatments. A 52-year-old man presented with a 20-year history of persistent, debilitating hiccups, often triggered after meals and resistant to pharmacological therapy. His symptoms had worsened in recent years, occasionally accompanied by reflux and vomiting, with minimal relief from anti-reflux medications and neural supplements. Further evaluation revealed pathological acid reflux and excessive supra-gastric belching, suggesting gastroesophageal reflux disease (GERD) as a contributing factor. After comprehensive assessment and informed consent, the patient underwent a series of ultrasound-guided interventions, including bilateral stellate ganglion blocks (SGBs) and phrenic nerve blocks. Although initial symptom relief was achieved, hiccups partially recurred, prompting the use of pulsed radiofrequency modulation (PNRF) of the phrenic nerve in combination with targeted analgesic injections. Following treatment, the patient experienced a significant and sustained reduction in hiccup frequency and severity, with only occasional brief relapses. Continued follow-up and additional sessions of phrenic nerve modulation resulted in further symptom control. This case underscores the effectiveness of integrating sympathetic and somatic nerve modulation, particularly ultrasound-guided SGB and PNRF, in cases of intractable hiccups. Such a multimodal, image-guided strategy may offer meaningful relief for patients suffering from chronic, treatment-resistant hiccups and demonstrates the value of personalized, interventional pain management in complex functional disorders.