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#36011 Ultrasound-guided superior laryngeal nerve block for diagnosis and treatment of neurogenic cough in a patient post-esophagectomy: a case report
  1. Iris Katarina Concepcion,
  2. Samantha Claire Martin-Braganza,
  3. Michael Ronald Madarang and
  4. Ray Carlo Escollar
  1. Department of Anesthesiology, St. Luke’s Medical Center- Global City, Taguig City, Philippines


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Background and Aims Chronic cough is cough lasting for more than 8 weeks, with a multifactorial cause including a hypersensitivity of the internal branch of the superior laryngeal nerve. Cough following esophagectomy in patients with esophageal carcinoma has been commonly associated with gastric reflux in 20-80% of patients. However, very few literature has described cough secondary to superior laryngeal nerve irritation as a complication of esophagectomy. Recent literature described the use of superior laryngeal nerve block using lidocaine and steroids for patients presenting with neurogenic cough. This paper presents a case of a 48 year-old male post-esophagectomy with gastric pull-up, complaining of persistent cough unrelieved by medical management.

Methods Trigger points of cough were identified. Superior laryngeal nerve block using lidocaine with dexamethasone was done, which resulted to immediate relief. However, symptom recurred in less than 24 hours. Six days after, the procedure was repeated using lidocaine with epinephrine and triamcinolone acetomide.

Results Cough severity index score of patient decreased from 40 to 20, with 70% decrease in the frequency of symptom. However, patient also noted a transient difficulty in swallowing.

Conclusions Superior laryngeal nerve block using lidocaine and steroids is a possible modality in the diagnosis and treatment of neurogenic cough as a complication of esophagectomy. Its effect is, however, temporary and should be done repeatedly to achieve significant results. Further studies should be done to determine the most effective combination of local anesthetic and steroid to achieve a desirable prolonged relief. One of the possible complication of the procedure is dysphagia.

  • Neurogenic Cough
  • Superior Laryngeal Nerve Block
  • Esophagectomy

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