Hadzic's Regional Anesthesia > Part III. Clinical Practice of Regional Anesthesia > Section Seven. Intravenous Regional Blocks for the Upper & Lower Extremity > Chapter 42. Ilioinguinal & Iliohypogastric Blocks Roy A. Greengrass, MD

Ilioinguinal & Iliohypogastric Blocks : Introduction

""Almost all cases of hernia, with the possible exception of those in young children, could undoubtedly be subjected to the radical operation under local anesthesia." This quote by Harvey Cushing reported in the Annals of Surgery in 1900 illustrates that over 100 years ago the attributes of regional anesthesia for lower abdominal and inguinal surgery were appreciated. Ilioinguinal and iliohypogastric blocks are among the most frequently used regional blocks performed for these surgical procedures. Postherniorrhaphy pain is moderate to severe and often poorly controlled with opioids as single modal therapy.¹ Ilioinguinal and iliohypogastric blocks have been shown to significantly reduce pain associated with herniorrhaphy, regardless of whether the blocks are used as the primary anesthetic² or for pain control after general^3,4 or spinal⁵ anesthesia.Both the iliohypogastric and ilioinguinal nerves emanate from the first lumbar spinal root. Superomedial to the anterior superior iliac spine, the iliohypogastric and ilioinguinal nerves pierce the transversus abdominis to lie between it and the internal oblique muscles. After traveling a short distance inferomedially, their ventral rami pierce the internal oblique to lie between the internal and external oblique muscles before giving off branches, which pierce the external oblique to provide cutaneous sensation. The iliohypogastric nerve supplies the skin over the inguinal region. The ilioinguinal nerve runs anteroinferiorly to the superficial..."