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Lomber Dorsal Kök Ganglion Pulsed Radyofrekans ve Transforaminal Steroid Enjeksiyonu Sonrasında Nadir Gözlenen Bir Komplikasyon: Hıçkırık

Yıl 2026, Cilt: 48 Sayı: 1, 145 - 147, 15.12.2025
https://doi.org/10.20515/otd.1688412

Öz

Epidural steroid enjeksiyonları, özellikle lomber disk hernisi ve radiküler ağrı durumlarında, ağrı tedavisinde sıkça kullanılmaktadır. Genellikle güvenli olmalarına rağmen, nadir komplikasyonlar zaman zaman ortaya çıkabilmektedir. Kronik radiküler ağrısı olan ve konservatif tedaviye yanıt vermeyen 43 yaşındaki erkek hasta, L4-L5 ve L5-S1 seviyelerine dorsal kök ganglion pulsed radyofrekans (DRG-PRF) ve ardından transforaminal steroid enjeksiyonu (TFESI) ile tedavi edilmiştir. İşlemden yaklaşık 20 saat sonra başlayan ve 48 saat süren, uykusunu bölecek şiddette inatçı hıçkırık gelişmiştir. Yapılan takip değerlendirmelerinde nörolojik veya sistemik herhangi bir patoloji saptanmamış; semptomlar medikal müdahale olmadan kendiliğinden gerilemiştir. Epidural enjeksiyon sonrası hıçkırık nadiren rapor edilmekle birlikte, göz ardı edilen bir komplikasyon olabilir. Klinik pratikte, kortikosteroidlere bağlı santral etkiler, epidural basınç değişimleri ya da otonom sinir sistemi dengesizlikleri olası mekanizmalar olarak değerlendirilmelidir. Bu olgu, bu tür atipik komplikasyonlara yönelik farkındalığın artırılması gerektiğini vurgulamaktadır.

Kaynakça

  • 1. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78-92.
  • 2. Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):Cd013577.
  • 3. Napoli A, Alfieri G, Scipione R, Andrani F, Leonardi A, Catalano C. Pulsed radiofrequency for low-back pain and sciatica. Expert Rev Med Devices. 2020;17(2):83-6.
  • 4. Hong LW, Chen KT. A real-world evidence of a consecutive treatment of 42 spine-related pain using dorsal root ganglion-pulsed radiofrequency (DRG-PRF). Clin Neurol Neurosurg. 2020;197:106186.
  • 5. Plastaras C, McCormick ZL, Garvan C, Macron D, Joshi A, Chimes G, et al. Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections. Spine J. 2015;15(10):2157-65.
  • 6. Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog. 2010;57(4):150-6; quiz 7.
  • 7. Kanniah SK. Acute transient hiccups after epidural injection of levobupivacaine. Int J Obstet Anesth. 2009;18(2):193-4.
  • 8. Beyaz SG. Persistent hiccup after lumbar epidural steroid injection. J Anaesthesiol Clin Pharmacol. 2012;28(3):418-9.
  • 9. Slipman CW, Shin CH, Patel RK, Braverman DL, Lenrow DA, Ellen MI, et al. Persistent hiccup associated with thoracic epidural injection. Am J Phys Med Rehabil. 2001;80(8):618-21.
  • 10. McAllister RK, McDavid AJ, Meyer TA, Bittenbinder TM. Recurrent Persistent Hiccups After Epidural Steroid Injection and Analgesia with Bupivacaine. Anesthesia & Analgesia. 2005;100(6):1834-6.
  • 11. Kaydu A, Kılıç ET, Gökçek E, Akdemir MS. Unexpected Complication after Caudal Epidural Steroid Injection: Hiccup. Anesth Essays Res. 2017;11(3):776-7.
  • 12. Ferhat, E. G. E. (2024). Persistent hiccups as a rare complication after transforaminal epidural steroid injection: A Case Report.
  • 13. Ramsay M, Roberts C. Epidural injection does cause an increase in CSF pressure. Anesthesia & Analgesia. 1991;73(5):668.
  • 14. Feldman S, Dafny N. Effects of adrenocortical hormones on the electrical activity of the brain. Progress in brain research. 1970;32:90-101.

Hiccup as a Rare Complication Following Lomber Dorsal Root Ganglion Pulsed Radiofrequency and Transforaminal Steroid Injection

Yıl 2026, Cilt: 48 Sayı: 1, 145 - 147, 15.12.2025
https://doi.org/10.20515/otd.1688412

Öz

Epidural steroid injections are frequently used in pain management, particularly in cases of lumbar disc herniation and radicular pain. Although generally safe, rare complications can occasionally arise.A 43-year-old male patient with chronic radicular pain unresponsive to conservative treatment was treated with dorsal root ganglion pulsed radiofrequency (DRG-PRF) followed by transforaminal steroid injection (TFESI) at the L4-L5 and L5-S1 levels. Approximately 20 hours after the procedure, the patient developed persistent hiccups lasting for 48 hours, severe enough to disrupt sleep. No neurological or systemic abnormalities were detected on follow-up evaluations. The symptoms resolved spontaneously without medical intervention.Although hiccups are rarely reported following epidural injections, they may be under-recognized. In clinical practice, it is important to consider corticosteroid-induced central effects, volume-related epidural pressure changes, or autonomic imbalance as possible mechanisms. This case highlights the need for awareness of such atypical complications.

Kaynakça

  • 1. Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78-92.
  • 2. Oliveira CB, Maher CG, Ferreira ML, Hancock MJ, Oliveira VC, McLachlan AJ, et al. Epidural corticosteroid injections for lumbosacral radicular pain. Cochrane Database Syst Rev. 2020;4(4):Cd013577.
  • 3. Napoli A, Alfieri G, Scipione R, Andrani F, Leonardi A, Catalano C. Pulsed radiofrequency for low-back pain and sciatica. Expert Rev Med Devices. 2020;17(2):83-6.
  • 4. Hong LW, Chen KT. A real-world evidence of a consecutive treatment of 42 spine-related pain using dorsal root ganglion-pulsed radiofrequency (DRG-PRF). Clin Neurol Neurosurg. 2020;197:106186.
  • 5. Plastaras C, McCormick ZL, Garvan C, Macron D, Joshi A, Chimes G, et al. Adverse events associated with fluoroscopically guided lumbosacral transforaminal epidural steroid injections. Spine J. 2015;15(10):2157-65.
  • 6. Becker DE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog. 2010;57(4):150-6; quiz 7.
  • 7. Kanniah SK. Acute transient hiccups after epidural injection of levobupivacaine. Int J Obstet Anesth. 2009;18(2):193-4.
  • 8. Beyaz SG. Persistent hiccup after lumbar epidural steroid injection. J Anaesthesiol Clin Pharmacol. 2012;28(3):418-9.
  • 9. Slipman CW, Shin CH, Patel RK, Braverman DL, Lenrow DA, Ellen MI, et al. Persistent hiccup associated with thoracic epidural injection. Am J Phys Med Rehabil. 2001;80(8):618-21.
  • 10. McAllister RK, McDavid AJ, Meyer TA, Bittenbinder TM. Recurrent Persistent Hiccups After Epidural Steroid Injection and Analgesia with Bupivacaine. Anesthesia & Analgesia. 2005;100(6):1834-6.
  • 11. Kaydu A, Kılıç ET, Gökçek E, Akdemir MS. Unexpected Complication after Caudal Epidural Steroid Injection: Hiccup. Anesth Essays Res. 2017;11(3):776-7.
  • 12. Ferhat, E. G. E. (2024). Persistent hiccups as a rare complication after transforaminal epidural steroid injection: A Case Report.
  • 13. Ramsay M, Roberts C. Epidural injection does cause an increase in CSF pressure. Anesthesia & Analgesia. 1991;73(5):668.
  • 14. Feldman S, Dafny N. Effects of adrenocortical hormones on the electrical activity of the brain. Progress in brain research. 1970;32:90-101.
Toplam 14 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Ağrı
Bölüm Olgu Sunumu
Yazarlar

Elif Göksu Yiğit Tekkanat 0000-0002-8946-2302

Beril Bayraktar 0009-0006-9315-2418

Mehmet Sacit Güleç 0000-0002-7107-3798

Ayten Bilir 0000-0002-3491-3209

Gönderilme Tarihi 1 Mayıs 2025
Kabul Tarihi 16 Temmuz 2025
Yayımlanma Tarihi 15 Aralık 2025
Yayımlandığı Sayı Yıl 2026 Cilt: 48 Sayı: 1

Kaynak Göster

Vancouver Yiğit Tekkanat EG, Bayraktar B, Güleç MS, Bilir A. Lomber Dorsal Kök Ganglion Pulsed Radyofrekans ve Transforaminal Steroid Enjeksiyonu Sonrasında Nadir Gözlenen Bir Komplikasyon: Hıçkırık. Osmangazi Tıp Dergisi. 2025;48(1):145-7.


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