Indian Journal of Clinical Anaesthesia 2023;10(2):216–217 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Clinical Anaesthesia Journal homepage: www.ijca.in Letter to Editor Acute transient hiccups after supraclavicular brachial plexus block: Is it a matter of concern? Ajitesh Sahu 1, *, Upendra Hansda 1 , Subhasree Das 1 , Seshendra Akella 1 , Supriya Kar 1 1 Dept. of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India ARTICLE INFO Article history: Received 28-04-2023 Accepted 19-05-2023 Available online 05-06-2023 This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com Sir, A 30-year-old male ASA (American Society of Anaesthesiologists) grade I patient was admitted for crush injury right forearm and planned for debridement and reconstruction. Written informed consent was taken, and he was explained about regional anaesthesia, the supraclavicular brachial plexus block, and its complications. He had a baseline heart rate (HR) of 72 bpm (beats per minute); blood pressure (BP) of 122/83 mmHg; oxygen saturation (SpO2) of 100% on room air and ECG showing sinus rhythm. He was premedicated with Inj. fentanyl 50 μg and Inj. midazolam 1 mg intravenously. Under aseptic precautions, with the patient in supine and slight head-up position, an ultrasound-guided (FUJIFILM Sonosite, Bothell, USA) right supraclavicular brachial plexus block was given via an in-plane approach, with 22G Quincke’s needle using the linear probe (HFL 38, 13-6 MHz). Bupivacaine (0.5%) 15ml + dexamethasone (8mg) 2 ml was administered for block after visualization of the needle tip and negative aspiration for blood. The block procedure was uneventful, and the patient did not have any haemodynamic abnormality throughout the procedure. Just two minutes after the completion of the block the patient started having hiccups. These hiccups persisted for a few minutes and were * Corresponding author. E-mail address: sahu.ajitesh84@gmail.com (A. Sahu). associated with increased BP (195/114 mmHg), initially raised HR of 111 bpm, and then sinus bradycardia (HR 56 bpm) (Figure 1). Oxygen was supplemented through a face mask though there was no fall in oxygen saturation. The patient was observed for any further haemodynamic instability. He was conscious and oriented during this period of the event and oxygen supplementation was continued with a face mask. After 3-5 minutes, the hiccups subsided and vital parameters resumed to normal (HR 72 bpm, BP 136/83 mmHg, SpO2 100%) without any treatment. The patient did not complain of any dyspnoea, nausea, or vomiting and did not have any sweating during this period. The regional block was adequate and the surgery continued uneventfully. He did not have any further hiccups perioperatively and was discharged the following day with oral analgesics. A hiccup is the sudden onset of erratic diaphragmatic and intercostal muscular myoclonus which are followed immediately by laryngeal closure, hence the abrupt air rush into the lungs induces the vocal cords to close leading to a “hic” sound. 1 The afferent pathways of the hiccup reflex arc have vagal, phrenic, and sympathetic (T6-T12) branches as their components and efferent pathways have motor fibers of the phrenic nerve to diaphragm, nerve to the glottis, and accessory nerves to intercostal muscles as their components. 2 Any stimulation or irritation of the hiccup arc triggers a hiccup. https://doi.org/10.18231/j.ijca.2023.045 2394-4781/© 2023 Author(s), Published by Innovative Publication. 216