Safe Inguinal Hernia Repair Under Local Anesthesia With Multimodal Anesthesia in a High-Risk Patient: A Case Report

Inguinal hernia repair under local anesthesia is a minimally invasive procedure and is particularly useful for older patients or those with significant comorbidities. However, local anesthesia alone may provide insufficient analgesia, leading to patient discomfort and intraoperative movement, which can compromise the surgical conditions. We report a case in which multimodal anesthesia enabled the safe surgical management of a high-risk patient. A 90-year-old man with a right inguinal hernia was referred to our hospital. Laboratory evaluation revealed anemia, and further investigations led to the diagnosis of gastric cancer. The patient subsequently underwent total gastrectomy. Postoperatively, he developed pneumonia, which improved with antibiotic treatment. At 30 days postoperatively, he was scheduled for an inguinal hernia repair. Given his severe emphysema due to long-term smoking and recent history of pneumonia, general anesthesia was considered high-risk. Therefore, the procedure was performed under local anesthesia supplemented with multimodal anesthesia, including dexmedetomidine sedation and ilioinguinal and iliohypogastric nerve blocks. Adequate sedation and analgesia were achieved without respiratory compromise, and the surgery was completed safely under stable operative conditions. Multimodal anesthesia combined with sedation and nerve blocks can overcome the limitations of local anesthesia alone and facilitate the safe surgical management of high-risk patients. This case highlights the importance of a tailored perioperative strategy and close collaboration between surgeons and anesthesiologists.