Inguinal hernia in an adult is the result of degenerative changes causing weakness of the transversalis fascia, and a surgical repair is the only treatment of choice. General, regional including spinal and epidural block, and local anesthesia modalities have been employed with their own advantages and disadvantages. Currently the developments of various local anesthetic agents, more experiences in local anesthesia procedures, advents of tension-free hernioplasty techniques, cost-effectiveness policy in managed care system, and adoption of ambulatory surgery care make local anesthesia practice more popular. Local anesthesia appears to be safe, effective, and economical with few side effects. Clinical guide of local anesthetics, practical groin neuroanatomy and injection techniques, and selection of patients for groin herniorhaphy under local anesthesia are reviewed to offer the practising surgeons an useful clinical and practical information.