Regional Anesthesia in a Cirrhotic Patient With Coagulopathy and Pulmonary Hypertension: A Case Report

End-stage liver disease increases perioperative risk due to cirrhosis-related complications such as portal hypertension, coagulopathy, ascites, encephalopathy, and impaired anesthetic metabolism. Although regional anesthesia may reduce these risks compared to general anesthesia, its use is often limited in this population due to coagulopathy and altered drug metabolism. We present the successful use of an axillary brachial plexus block with bupivacaine for olecranon bursa excision in a 72-year-old man with ASA (American Society of Anesthesiologists) IV physical status classification and a MELD-Na (Model for End-Stage Liver Disease-Sodium) score of 15, complicated by coagulopathy, portal hypertension, and pulmonary hypertension. This case highlights the feasibility of regional anesthesia in high-risk cirrhotic patients with abnormal coagulation profiles.