In Reply:-We did not claim that “the failure of simple hiccup-terminating maneuvers warrants proceeding directly to potentially damaging 'last-resort' maneuvers such as phrenic nerve interruptions.” Instead, we fully agree with Dr. Petroianu's claim that “the logical next step (after failure of simple maneuvers) is the use of appropriate drugs.” Our statement, “block of the phrenic nerve has been suggested as 'the last resort,”' [1]means that the use of this block should be considered if other less-invasive methods, including the use of potentially effective drugs, have failed. Most patients with intractable hiccups are referred from other departments in which a variety of methods, including potentially effective drugs such as baclofen, have been used in vain, although we did not described these explicitly.

The main point we made in our report [1]was not advocating the phrenic nerve block but that the use of electric nerve stimulation enables one to avoid unnecessary attempts at repeated blocks. In fact, in one of our patients, [1]we judged that a successful block of the phrenic nerve would not decrease hiccups and abandoned this method. There is no “holy grail” for intractable hiccups: neither baclofen nor phrenic nerve block is always effective. The importance-we believe-is to judge whether each treatment method is effective in each patient and to stop ineffective methods at an early stage.

Yasuhisa Okuda, M.D.

Associate Professor of Anesthesiology;

Toshimitsu Kitajima, M.D.

Professor; First Department of Anesthesiology; Dokkyo University School of Medicine; Mibu, Tochigi, Japan

Takashi Asai, M.D., Ph.D.

Research Associate; Department of Anesthesiology; Kansai Medical University; Osaka, Japan

(Accepted for publication July 7, 1998.)

Okuda Y, Kitajima T, Asai T: Use of a nerve stimulator for phrenic nerve block in treatment of hiccups. Anesthesiology 1998; 88:525-7