Awake endoscopic retrograde cholangiopancreatography in an ASA 4 patient using glossopharyngeal block: A case report

Awake endoscopic retrograde cholangiopancreatography (ERCP) is infrequently performed, especially in patients with significant comorbidities. This case report documents the successful use of glossopharyngeal nerve block (GPNB) as the primary anaesthetic for an American Society of Anaesthesiologists (ASA) physical status class 4 male, 71 years old, with significant cardiac, pulmonary, and hepatobiliary comorbidities, who underwent awake ERCP with minimal intravenous sedation. The glossopharyngeal block effectively reduced the gag reflex and provided sufficient anaesthetic, allowing for the successful completion of ERCP without difficulties. The higher risk associated with general anaesthesia or deep sedation in this high-risk patient necessitated this approach.