Ilioinguinal – Iliohypogastric Nerve Block

Anatomy
The nerves are formed by the ventral rami of L1/L2 and L12/L1, respectively. Both nerves
emerge from the lateral border of the psoas manor muscle, pass across the ventral surfaces of the
quadratus lumborum muscle and run in a distal direction medial to the iliac crest. Medial to the
anterior superior iliac spine, the nerves pierce the transverse abdominal muscle and are in a
position between the internal oblique and transverse abdominal muscle. The ilioinguinal and
iliohypogastric nerves may arise as a common trunk and become separated between the internal
oblique and transverse abdominal muscles. The ilioinguinal nerve may be absent in some case.

Ultasound Scan Technique

1. Patient position : supine
2. Landmark : the ilioinguinal and iliohypogastric nerves medial to the anterior superior iliac
spine are usually loacted between the internal oblique and transverse abdominal muscles.
3. US probe position : transverse scan

Transverse sonogram of the inguinal region in an adult volunteer, from the level of the anterior superior
iliac spine (ASIS), showing the ilioinguinal and iliohypogastric nerves and their relation to the abdominal
musculature. EOM, indicates external oblique muscle, IOM, internal oblique muscle, and TA – transverse
abdominis.
 Transverse sonogram of the inguinal region in a child, from the level of the anterior superior iliac spine
(ASIS). Note that unlike that in the adult only two layers of muscle i.e. the IO, internal oblique and TA,
transversus abdominis muscle are visualized. The external oblique muscle is seen as a hyperechoic
aponeurotic layer at this level. The ilioinguinal and iliohypogastric nerves are seen in between the IO and
TA muscle at this level.

Ilioinguinal iliohypogastric nerve block in a child. Note the block needle (insert image) is inserted in-
plane and from a medial to lateral direction toward the iliac bone. We prefer this aproach to avoid
inadvertent deep needle insertion and potential bowel punture. ASIS, indicates anterior superior iliac
spine, IO, internal oblique muscle, and TA, transverse abdominis muscle.
Ilioinguinal iliohypogastric nerve block in a child. Transverse sonogram of the inguinal region after the
local anesthetic injection. Note the extensive spread of the local anesthetic. TA, indicates transversus
abdominis muscle.