Temporary femoral nerve palsy after ilioinguinal nerve blockade combined with splash block for post-inguinal herniorrhaphy analgesia in a pediatric patient

Transient femoral nerve palsy (TFNP) is a complication of ilioinguinal nerve block that may result from spread of large volumes of local anesthetics at the inner surface of the different fascial planes. We report a 7-year-old healthy boy who underwent right inguinal hernia repair under general anesthesia. After induction of anesthesia, a percutaneous ilioinguinal nerve block was performed with 3 mL of 2% lidocaine in single-shot. Before wound closure, the surgeon performed a splash block onto the wound with infiltration of 1.5 mL 0.25% bupivacaine. In the recovery room, quadriceps weakness and sensory loss over the anterior thigh were noted. The patient made a complete recovery 8 hrs after surgery without any treatment. We discuss the mechanism of this complication and strategies to reduce this complication.