Objective: To explore the value of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IINB) in tension-free inguinal hernia repair in elderly patients. Methods: A total of 70 elderly patients with tension-free inguinal hernia repair who treated in the hospital from April 2018 to November 2019 were selected and divided into two groups according to the random number table method, with 35 cases each. The control group underwent infiltration of local anesthesia(LA), and the study group added with IINB. The visual analogue scale (VAS) scores of the two groups of patients were compared. Results: The VAS score of the study group when pulling the hernia sac was lower than that of the control group, and the difference was statistically significant (P<0.05). Conclusion: IINB has good analgesic effect in tension-free inguinal hernia repair in elderly patients, and it is worth promoting.