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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Inguinal hernioplasty (IHP) is one of the most common pediatric surgeries. Lateral TAP (LTAP), and ilioinguinal/iliohypogastric (IL-IH) block have been used for analgesia following IHP, with reports of incomplete block following their sole application. Combining these two blocks may provide surgical anesthesia of the anterolateral abdominal wall bellow the T9-T10 level.Methods We retrospectively analyzed patient data at the University Children’s Hospital in Belgrade from January 1st 2023 to December 31st 2024. A total of 72 patients underwent IHP under procedural sedation and ultrasound guided equal volume LTAP and IL-IH block (Lidocaine 3.12±0.4 mg/kg, Levobupivacaine 1.62±0.2 mg/kg). Postoperative pain was assessed at 1 h and 3 h via children and infants postoperative pain scale (CHIPPS), Wong Baker Faces pain rating scale, and Numerical Rating Scale (NRS). Local ethics committee approval was obtained.Results All 47 (65.28%) boys and 25 (34.72%) girls, aged 1 month to 12 years, followed NPO guidelines and none of them presented with risk of regurgitation. Following induction with Atropine, Fentanyl, and Propofol, sedation was maintained with continuous Propofol. Intraoperatively perfect hemodynamic and respiratory stability were noted in all 72 patients breathing spontaneously, with total opioid consumption limited to average of 1.2 mcg/kg Fentanyl on induction. No nausea or vomiting were noted. Postoperative pain scores at 1 h indicated no pain, and only mild pain at 3 h (70.83%).Abstract P109 Figure 1Ultrasound anatomy and local anaesthetic spreadAbstract P109 Figure 2Local anaesthetic doseConclusions Combining LTAP and IL-IH block provides surgical anesthesia for inguinal hernia repair in children, with excellent postoperative analgesia. Spontaneous breathing eliminates complications associated with endotracheal intubation and general anesthesia, but preparation for immediate airway management is imperative.