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

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.