Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report  

作　　者：Yui Ikuta Hideya Kato Yuko YNishiwaki Junko Tamura Ryuhei Araki Shinji Nozuchi Yui Ikuta;Hideya Kato;Yuko YNishiwaki;Junko Tamura;Ryuhei Araki;Shinji Nozuchi(Department of Anesthesiology, Saiseikai Shiga Hospital, Ritto, Japan)

机构地区：[1]Department of Anesthesiology, Saiseikai Shiga Hospital, Ritto, Japan

出　　处：《Open Journal of Anesthesiology》2022年第3期105-112,共8页麻醉学期刊（英文）

摘　　要：Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.

关 键 词：COPD Hernia Repair Peripheral Nerve Block Epidural Anesthesia 

分 类 号：R61[医药卫生—外科学]