CommentBased on this sample, an estimated 3 % of all entrants were sufficiently incapacitated by a training injury to prevent them from running, and an estimated 59% of all runners suffered some ill effects. These were severe enough to warrant medical care in only a trivial proportion of cases, however, and had little effect on working or social life. The race organisers advised entrants on how to prepare for the race. The small numbers of casualties occurring during the race (see our accompanying paper) and the relative unimportance of the after effects suggest that they took heed of the advice.Older and more experienced runners were least affected. The increased opportunities that exist to compete in open-entry marathons means that the numbers with previous experience is growing. Even fewer problems before, during, and after the race should result.We thank the South Yorkshire branch of the British Red Cross Society, the organising committee of the Sheffield Marathon, and Mr John Whetton, race director, for the facilities to undertake this study.( Local analgesia has become an accepted part of anaesthesia for paediatric surgery, particularly for minor surgery that can be planned on a day-stay basis. The most frequently used method is a caudal epidural injection, which has been shown to be effective in patients undergoing circumcision using a low volume of local anaesthetic solution.' 2 Pain relief for operations using a groin incision, however, requires a much larger volume of solution.3 We describe the use of ilioinguinal nerve blocks in postoperative analgesia in children undergoing inguinal herniotomy.
Patients, methods, and resultsAll 120 patients booked for inguinal herniotomy on a surgical day-stay list were studied. Those under 5 years old were given premedication consisting of oral diazepam and droperidol. General anaesthesia was induced either intravenously with thiopentone sodium, 5 mg/kg body weight, or by an inhalational technique, and was maintained with nitrous oxide, oxygen, and halothane breathed spontaneously from a suitable system. After induction the patients were divided at random into two equal groups: the first group received no local analgesia; the second group had an ilioinguinal block performed using 0-5% bupivacaine without adrenaline, to a total volume of 4 ml/year of age. The major nerve supply to the groin is from the ilioinguinal and iliohypogastric nerves, which lie close together below the external oblique muscle, a finger's breadth from the anterior superior iliac spine. A hypodermic needle was inserted vertically at this point until the aponeurosis of the external oblique was penetrated. After aspiration, the analgesic solution was injected below the aponeurosis, laterally towards the iliac spine and mediocaudally towards the inguinal ligament.4The patients were assessed at one, two, and four hours after operation by one of two experienced nurses, neither of whom knew whether a local analgesic had been given. Paracetamol was also given if the nurses thought it necessary and, if...
