# Hepatic Hilar Nerve Block as an Adjunct to Moderate Sedation for Microwave Ablation of Hepatocellular Carcinoma: A Case Report

## TL;DR

A hepatic hilar nerve block combined with moderate sedation successfully controlled pain during liver tumor ablation in a patient with cirrhosis.

## Contribution

This case report demonstrates a novel use of hepatic hilar nerve block as an alternative to general anesthesia for microwave ablation of hepatocellular carcinoma.

## Key findings

- The patient experienced excellent pain control with a VAS score of 3/10 during hospitalization.
- No opioids were needed for pain management, and the patient reported no pain at one-week follow-up.
- The procedure was completed successfully without complications or escalation to general anesthesia.

## Abstract

Effective pain control is a key determinant of safety and technical success during percutaneous liver tumor ablation, particularly for microwave ablation (MWA), which is associated with significant visceral pain. General anesthesia (GA) is frequently used but may be unavailable in many institutions and may increase peri-procedural risk in patients with cirrhosis. We report a technically focused case highlighting the educational value of a hepatic hilar nerve block as an adjunct to moderate sedation during MWA of hepatocellular carcinoma (HCC). A 71-year-old man with hepatitis C-related cirrhosis and residual HCC after transarterial chemoembolization underwent percutaneous MWA using moderate sedation combined with a hepatic hilar nerve block. The procedure was completed successfully without escalation to GA, with excellent intra- and post-procedural analgesia and no complications. During hospitalization, the patient reported only mild pain with a visual analog scale (VAS) score of 3/10, which was controlled with acetaminophen alone without opioids. At one-week follow-up, the patient reported no pain with a VAS score of 0/10.