The analgesic efficacy of paravertebral block at T11 level as a single anaesthetic technique in an older adult with severe cardiac insufficiency undergoing open complex inguinal hernia repair: A case report

Background: We describe a case of severe cardiac insufficiency in an older adult undergoing open complex inguinal hernia repair. We present paravertebral injection technique at lower vertebral level without additional needle entry. The feasibility of this technique was verified by observing its intraoperative and postoperative analgesic effects. Case presentation: A 91-year-old male patient was admitted to the hospital with a very large mass in the right lower abdomen. Diagnostic ultrasonography revealed right inguinal irreducible hernia. The patient had severe cardiac insufficiency with a high risk of general and spinal anaesthesia. After adequate preoperative evaluation and cardiac therapy, the anesthesiologist determined to perform paravertebral block at T11 level using 20 mL of ropivacaine (0.5%) as a single anaesthetic technique to complete the operation. The surgery went uneventfully without using any auxiliary analgesics or sedative drugs. The first reported pain was 19 h after surgery. On the 11-point numeric rating scale, the highest and lowest pain scores within the first 24 h were 3 and 0, respectively. On postoperative day three, the patient was discharged and recovered without complications in 7 days and underwent one-month follow-up. Conclusions: Single paravertebral block at T11 level with 20 mL of ropivacaine (0.5%) may be an effective intraoperative anaesthetic technique in older adults with severe cardiac decompensation undergoing complex open inguinal hernia repair. The advantage of this technique was that the ipsilateral somatic and sympathetic nerves above and below the injection site could be blocked without additional needle insertion.