Ilioinguinal/Iliohypogastric Block

Patient Position: The patient lies supine.

Indications:
The simultaneous block of these two nerves provides anesthesia for
surgery on the inguinal region: hernia repair, orchidopexy, hydrocele.

Needle Size: A short beveled needle (e.g., a caudal needle).

Volume: 0.2 to 0.3 ml/kg of ropivacaine 0.2% for children up to 7 years, levobupivacaine 0.5% for older children.

Anatomic Landmarks: Anterior superior iliac spine and the umbilicus (Fig. 52-1).

Approach and Technique:
The line uniting the anterior superior iliac spine to the umbilicus is
divided in four equal parts. A short beveled needle is then introduced
vertically at the union of the most lateral part to the medial
three-quarters of the line. The needle is introduced perpendicular to
the skin until there is a loss of resistance, corresponding to the
piercing of the superficial layer of the external oblique muscle.

Recently, Willschke, Marhofer, and Bosenberg
demonstrated with the use of the ultrasound technique that the landmark
is more lateral compared to the previous point of injection: less than
1 cm medial to the anterior superior iliac spine and in a double blind
study they succeeded in reducing the amount of administered drug in the
ultrasound group—only 1 to 2 mL—with an increase in duration of
analgesia.