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Ilioinguinal and iliohypogastric nerve block revisited: single shot versus double shot technique for hernia repair in children


Suan-Ling Lim Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore (e-mail:


Background: We attempted to determine the efficacy of a one plane ilioinguinal and iliohypogastric nerve block with a single shot and double shot techniques.

Methods: In a randomized single blind study, 90 children, aged 2–12 years, received a single shot (SS) or a double shot (DS) technique for ilioinguinal and iliohypogastric (IG–IH) nerve block for inguinal hernia repair. In the SS group, 0.25 ml·kg–1 of 0.25% bupivacaine was given one fingerbreadth medial to the anterior superior iliac spine under the external oblique aponeurosis. In the DS group, one-third of the total dose of bupivacaine was given as for the SS group. The remaining two-thirds was deposited 0.5 cm above and lateral to the mid-inguinal point deep to the external oblique aponeurosis.

Results: The success rates of both techniques were similar, at 72%, although the presence of local anaesthetic in the inguinal canal was significantly higher with the DS technique. The incidence of femoral nerve block was 4.5% with the SS and 9% with the DS technique (P > 0.05). Parental satisfaction with postoperative pain relief was high, at 94%.

Conclusions: The DS technique, while technically more difficult, does not improve the success rate of the IG–IH nerve block compared with the SS technique.

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