Initially, intractable postoperative hiccups can be treated using innocuous, topical and stimulating therapies such as rapidly swallowing water or ice chips, breath holding, and re-breathing from a paper bag, according to the National Institutes of Health. If they persist, pharmacological intervention can be considered. Chlorpromazine is most frequently cited and is the only agent that has been tried enough to receive U.S. Food and Drug Administration approval for this indication, according to the NIH.
Triggering events for hiccups in patients undergoing medical procedures and under sedation/anesthesia include distension of the stomach during bag-valve-mask ventilation, intra-operative manipulation of the diaphragm, and anesthetic medications such as methohexital, midazolam and opoids, according to the International Anesthesia Research Society.
If intractable hiccups persist after surgery, despite attempts with innocuous remedies, Chlorpromazine can be administered as a single dose of 25 to 50 milligrams or can be prescribed orally as 25 milligrams three times daily, according to the NIH. The use of proton pump inhibitors is an effective targeted therapy for hiccups attributable to gastroesophageal reflux disease, according to the NIH. Lidocaine, both intravenous and nebulized, has been reported in several case studies of intractable hiccups, and metoclopramide, with a brand name of Reglan, is recommended to promote gastric emptying, according to the IARS.
Hiccups are involuntary contractions of the diaphragm, the muscle that separates the chest from the abdomen and plays an important role in breathing. Each contraction is followed by a sudden closure of the vocal cords, which produces the characteristic "hic" sound. Hiccups that last longer than 48 hours are called persistent hiccups, while those that last longer than a month are called intractable hiccups, according to WebMD.