The former president underwent procedures to block the phrenic nerve, but the hiccups persisted. Find out why the problem may persist and how the procedure is carried out
In just four days, the former president Jair Bolsonaro underwent three procedures to try to alleviate persistent hiccups. The most recent of them took place in the afternoon of Tuesday 30. According to family members and medical reports, the interventions were aimed at block the phrenic nerve. But what is the role of this nerve in hiccups and why does the problem persist even after successive interventions?
First of all, you need to understand what is hiccup and how it is triggered. According to Paulo Barros, digestive system surgeon at the Specialized Center for the Digestive System of the Alemão Oswaldo Cruz HospitalThis is an involuntary contraction of the diaphragm (main respiratory muscle) that occurs when there is irritation of the phrenic nerves.
These nerves are located between the neck and chest and are responsible for sending motor stimuli to the diaphragm. Most of the time, the doctor explains, they suffer from irritation due to problems such as excessive consumption of food or drink, sudden changes in temperature or gastroesophageal reflux. In these cases there may be hiccups, but this is something occasional and temporary.
However, there are situations in which hiccups persist longer. According to the specialist, these conditions are usually linked to the impact of abdominal or thoracic surgeries, which can irritate the phrenic nerves.
Examples cited by Barros include cases of fluid or tissue accumulation (collections) after surgery. pancreasfor example, or a partial obstruction of the intestine after several abdominal operations. In the latter case, intestinal transit being impaired, gastric emptying is slower, which can irritate the phrenic nerve and trigger hiccups.
Barros says that even in the case of patients with persistent hiccups after surgery, the problem usually goes away. “Only in rare cases do we have to resort to medication or block the phrenic nerve,” explains the doctor.
How does a phrenic nerve block take place?
According to the surgeon, blocking the phrenic nerves is done through the application of medications that prevent the nerve from sending motor impulses to the diaphragm, thus preventing the involuntary contractions that cause hiccups. “We generally use anesthetics, which can be combined with corticosteroids (class of drugs with anti-inflammatory function),” he explains.
The medication is usually administered using an ultrasound or CT scan to guide the doctor on the location of the nerves. The patient may be sedated or given anesthesia to make them more comfortable during the procedure, which usually lasts an hour and a half.
Why hiccups may persist even after a nerve block
The surgeon explains that it is not uncommon for several nerve block procedures to be necessary for the patient to see improvement.
This is because the phrenic nerve is only 2 to 3 millimeters wide and usually does not show up clearly on imaging tests. Therefore, multiple applications may be required for application to be accurate and blocking to be successful.
Barros emphasizes, however, that the procedure is not a curative treatment, it only seeks to alleviate seizures and provide the patient with quality of life until the source of the problem is resolved.
In the case of a partial intestinal obstruction, for example, it must be resolved, either with medication or surgery, to minimize the risk of new hiccups.
“Phrenic nerve block is a ‘bridging treatment’ that aims to provide quality of life while the patient improves on other conditions or until they are ready for another surgical procedure, if necessary,” explains the doctor.
Steps taken by Bolsonaro
The blockade carried out by Bolsonaro’s medical team this Tuesday is the third to which Bolsonaro has been subjected since he underwent surgery to correct an inguinal hernia on the 25th.
The first blocking procedure took place on Saturday 27th, after severe hiccups the previous night which led to difficulty sleeping. At the time, the block was performed on the right side of the nerve. On Monday 29, a new procedure type, this time directed towards the left nerve.
The former president has undergone several abdominal surgeries to treat intestinal obstructions since he was stabbed during the 2018 election campaign.
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