Indications:

• Hernia, hydrocoele, orchidopexy

Note:

• Performed when child asleep, after induction of anaesthesia
• Not 100% reliable; be prepared to give supplementary analgesia intra-operatively if inadequate block
• 10% may get additional femoral nerve block (leg weakness – care with postop mobilisation)
• May not cover scrotum for orchidopexy
• Supplement with simple analgesics post-op
• With the use of ultrasound guidance the typical complications of a landmark-based technique such as femoral nerve block and intestinal puncture can be avoided

Procedure:

• 23G needle, 0.5 ml/kg, maximum 20 ml LA total volume
• Injection point is the child's finger breadth medial to anterior superior iliac spine – insert the needle perpendicular to the skin
• Gently advance until 'pop'/ loss of resistance felt (the external oblique aponeurosis and the internal oblique muscle).
• Inject after negative aspiration
• Use 2 ml for sub-cutaneous fan infiltration

The analgesia can be further improved by:

• Another injection immediately lateral to pubic tubercle to block the nerves coming from the opposite side
• Local infiltration along the line of incision