Williams, J.W., Cox, C.E., Hargett, C.W., Gilstrap, D.L., Castillo, C.E., et al. (2012) Noninvasive Positive-Pressure Ventilation (NPPV) for Acute Respiratory Failure. Report No. 12-EHC089-EF, Agency for Healthcare Research and Quality (US), Rockville.

has been cited by the following article:

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

  AUTHORS: Yui Ikuta, Hideya Kato, Yuko YNishiwaki, Junko Tamura, Ryuhei Araki, Shinji Nozuchi

  KEYWORDS: COPD, Hernia Repair, Peripheral Nerve Block, Epidural Anesthesia

  JOURNAL NAME: Open Journal of Anesthesiology, Vol.12 No.3, March 22, 2022

  ABSTRACT: 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.