Lateral to the rectus muscle are three layers of muscles – External Oblique, Internal Oblique and Transversus

Abdominis. These muscles are arranged obliquely to each other.

Under these are Fascia Transversalis, Extra-Peritoneal Fascia and Peritoneum.

Anatomy of Groin, Inguinal Ligament and Canal

Inguinal (or Poupart’s) Ligament is the inferior edge of the External Oblique Aponeurosis, with a posterior turn creating a
shelf which extends from the Anterior Superior Iliac Spine to Pubic Tubercle. An extension of this ligament is the Lacunar
Ligament which is reflected backward as Pectineal (or Cooper’s) Ligament and inserts into the Pectineal Line. The Lacunar
Ligament forms the medial boundary of the Femoral Canal.
In the External Oblique Aponeurosis is an Ovoid Opening, the Superficial Inguinal Ring. It is present Superior and Lateral to
Pubic Tubercle.
The Internal Oblique laterally forms the Cremasteric Muscle which surrounds the Spermatic Chord (Round Ligament in
women) and continues in the Inguinal Canal. Medially it merges with the Transversus Abdominis forming the Conjoint
tendon, inserting into the Pubic Tubercle.
The Transversus Abdominis arches over the Deep Inguinal Ring and then merges with Internal Oblique. The arch is known
as the Aponeurotic Arch.
Deep Inguinal Ring is a defect in the Fascia Transversalis. Fascia Transversalis is a aponeurotic membrane covering the
internal surface of Transvesus Abdominis. The Ring is located slightly above the Mid-Point of Inguinal Ligament.
Ilio-Pubic Tract is the region behind the Inguinal Ligament formed from Transversus Abdominis and Fascia Transversalis,
an important area to be localized during repair, where in staples should not be placed lateral to the deep inguinal ring owing
to the presence of Lumbar Plexus.
Inguinal Canal is a 4 cm long tube like structure directed infero-medially and anteriorly between Deep and Superficial Inguinal Rings. The main
contents are Spermatic Cord (in men) and Round Ligament (in women) and Ilio-Inguinal Nerve.

Spermatic Cord – A cord like structure containing nerves, vessels and other structures that run to and from the testis.

Vasculature of importance in and around the groin constitutes, the Inferior Epigastric Vessels which differentiate between Direct Inguinal Hernia
(medial swelling) and Indirect Inguinal Hernia (lateral swelling).
 ilioinguinal and iliohypogastric nerve block has long been considered a suitable anesthetic method for both children and adult patient
populations during surgical procedures in the inguinal region, mainly hernia repairs
What is the landmark of the inguinal block?

Ilioinguinal nerve L1 – supplies upper part of penis in men and scrotum and mons pubis and
labia majora in women - can be affected in open groin surgery – supplies
Iliohypogastric nerve L1 – supplies skin in the pubic area and round to upper part of thigh
and buttock - Also can be exposed in open and laparoscopic hernia surgery
Genital branch of Genitofemoral nerve L1-2 (upper branch) – supplies scrotal skin and
found in the inguinal ligament cord structures – can be affected in either operation by mesh
irritation and/or damage

The landmarks for this block are ASIS, the pubic tubercle, and the inguinal ligament. Once the inguinal ligament is marked, it is trisected and
then a point-one fingerbreadth (1 cm) below the junction of the medial 2/3rd and the lateral 1/3rd is marked (Figure 15). This is the point of
the needle insertion.
Spermatic cord anesthesia block (SCAB) The technique involved first identifying the spermatic cord and
cremasteric artery. Once the SC was identified (Figure 2), 5ml of 1% xylocaine and 5 ml of 0.5% bupivacaine were
combined in a single syringe with a #21 gauge 1.5-inch needle. The skin site was prepared and draped and the SC
was palpated. Approximately 8 cc’s of the anesthetic solution was injected in and directly around the SC (Figure 4).
The patient reported nearly immediate symptomatic relief