Regional Anaesthesia Severe COPD — FRCA Final MCQ

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ModerateRegional AnaesthesiaRegional Anaesthesia Severe COPDFRCA Final

A 65-year-old man (ASA III) with end-stage COPD (FEV1 0.6L) requires a right inguinal hernia repair. He is unable to lie flat due to orthopnoea. What regional anaesthetic technique avoids the risks of both general and neuraxial anaesthesia in this patient?

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Correct answer: E — Ilioinguinal and iliohypogastric nerve block with local infiltration

In a patient with severe COPD who cannot lie flat and has very limited respiratory reserve, ilioinguinal and iliohypogastric nerve blocks combined with local infiltration by the surgeon provides excellent surgical anaesthesia for inguinal hernia repair without the respiratory risks of GA (intubation, positive pressure ventilation, residual NMB) or high neuraxial block (intercostal muscle weakness, reduced cough, hypotension). The procedure can be performed with the patient semi-recumbent if needed. This approach preserves respiratory function entirely.

Reference: RCOA – 2023 – Regional anaesthesia and preoperative assessment modules