Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report
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.
References
[1]
Hausman, M.S., Jewell, E.S. and Engoren, M. (2015) Regional versus General Anesthesia in Surgical Patients with Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce the Risk of Postoperative Complications? Anesthesia and Analgesia, 120, 1405-1412. https://doi.org/10.1213/ANE.0000000000000574
[2]
Hajizadeh, N., Gold-feld, K. and Crothers, K. (2015) What Happens to Patients with COPD with Long-Term Oxygen Treatment Who Receive Mechanical Ventilation for COPD Exacerbation? A 1-Year Retrospective Follow-Up Study. Thorax, 70, 294-296. https://doi.org/10.1136/thoraxjnl-2014-205248
[3]
Steinbrook, R.A., Concepcion, M. and Topulos, G.P. (1988) Ventilatory Responses to Hypercapnia during Bupivacaine Spinal Anesthesia. Anesthesia and Analgesia, 67, 247-252. https://doi.org/10.1213/00000539-198803000-00007
[4]
Gucev, G., Yasui, G.M., Chang, T.Y. and Lee, J. (2008) Bilateral Ultrasound-Guided Continuous Ilioinguinal-Iliohypogastric Block for Pain Relief after Cesarean Delivery. Anesthesia and Analgesia, 106, 1220-1222. https://doi.org/10.1213/ane.0b013e3181683821
[5]
Sasaoka, N., Kawaguchi, M., Yoshitani, K., Kato, H., Suzuki, A., et al. (2005) Evaluation of Genitofemoral Nerve Block, in Addition to Ilioinguinal and Iliohypogastric Nerve Block, during Inguinal Hernia Repair in Children. British Journal of Anaesthesia, 94, 243-246. https://doi.org/10.1093/bja/aei031
[6]
Tanaka, M., Azuma, S., Hasegawa, Y., Mori, N., Takahashi, N., et al. (2009) Case of Inguinal Hernia Repair with Transversus Abdominis Plane Block and Rectus Sheath Block. Masui. The Japanese Journal of Anesthesiology, 58, 1306-1309.
[7]
Miskovic, A. and Lumb, A.B. (2017) Postoperative Pulmonary Complications. British Journal of Anaesthesia, 118, 317-334. https://doi.org/10.1093/bja/aex002
[8]
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.
[9]
Langsetmo, L., Platt, R.W., Ernst, P. and Bourbeau, J. (2008) Underreporting Exacerbation of Chronic Obstructive Pulmonary Disease in a Longitudinal Cohort. American Journal of Respiratory and Critical Care Medicine, 177, 396-401. https://doi.org/10.1164/rccm.200708-1290OC
[10]
Xu, W., Collet, J.P., Shapiro, S., Lin, Y., Yang, T., et al. (2010) Negative Impacts of Unreported COPD Exacerbations on Health-Related Quality of Life at 1 Year. The European Respiratory Journal, 35, 1022-1030. https://doi.org/10.1183/09031936.00079409
[11]
Suzuki, M., Makita, H., Ito, Y.M., Nagai, K., Konno, S., et al. (2014) Clinical Features and Determinants of COPD Exacerbation in the Hokkaido COPD Cohort Study. The European Respiratory Journal, 43, 1289-1297. https://doi.org/10.1183/09031936.00110213
[12]
Hurst, J.R., Vestbo, J., Anzueto, A., Locantore, N., Müllerova, H., et al. (2010) Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease. The New England Journal of Medicine, 363, 1128-1138. https://doi.org/10.1056/NEJMoa0909883
[13]
Seemungal, T.A., Hurst, J.R. and Wedzicha, J.A. (2009) Exacerbation Rate, Health Status and Mortality in COPD—A Review of Potential Interventions. International Journal of Chronic Obstructive Pulmonary Disease, 4, 203-223. https://doi.org/10.2147/COPD.S3385
[14]
Albertson, T.E., Chenoweth, J.A., Pearson, S.J. and Murin, S. (2020) The Pharmacological Management of Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome (ACOS). Expert Opinion on Pharmacotherapy, 21, 213-231. https://doi.org/10.1080/14656566.2019.1701656
[15]
GBD 2015 Chronic Respiratory Disease Collaborators (2017) Global, Regional, and National Deaths, Prevalence, Disability-Adjusted Life Years, and Years Lived with Disability for Chronic Obstructive Pulmonary Disease and Asthma, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015. The Lancet Respiratory Medicine, 5, 691-706.
