Introduction: spinal anaesthesia is most widely employed form of regional anaesthesia for lower abdominal and lower limb surgery. Hernioplasty under local anaesthesia is an acceptable alternative to spinal anaesthesia especially with regard to operative condition, patient’s satisfaction, surgeon’s satisfaction, post-operative pain relief, complications and cost effectiveness. The aim of our study was to compare the efficacy and safety of ilioinguinal iliohypogastric nerve block with spinal anaesthesia for inguinal hernia surgery. Material and Methods: The study was a prospective randomized double blind study conducted in 80 patients of ASA Grade I, II and III of age group 30-70 years undergone unilateral open inguinal hernia repair. Patients were randomly divided into two groups with 40 patients in each group. Group I patients received 3 ml (15 mg) of 0.5% hyperbaric bupivacaine intrathecally in lateral decubitus position at L4-L5 lumbar interspace and will be immediately turned supine (spinal anaesthesia group). Group II patients received Ilioinguinal Iliohypogastric nerve block with 0. 5% ropivacaine combined with dexmedetomidine 1µg/kg at 2 cm medial and 2 cm above the anterior superior iliac spine (IHNB group). Time of onset of analgesia, duration of surgery and duration of post-operative analgesia were monitored. Haemodynamic parameters, Sedation score, Intra-operative complications, time to ambulation were noted. Patient satisfaction, Surgeon satisfaction were assessed. Postoperatively, VAS score was recorded hourly for six hours. Results: Mean blood pressure showed statistically significant reduction in first 25 minutes Group I patients, there was significant difference between both the groups (p value<0.05). The duration of analgesia in group I was 194. 60±35. 7 minutes and in group II was 413.90±13.2 minutes. It was statistically highly significant as the p value was <0.05. The duration of postoperative analgesia was longer in Group II (p<0.05). The time to ambulation in group I and group II was 291.25±32.24 mins and 119.90±26.98 mins respectively. Duration of ambulation was significantly shorter in Group II (p<0.05). Conclusion: Our study concluded that iIlioinguinal iliohypogastric nerve block provides better intra-operative hemodynamic stability, prolonged the duration of postoperative anaesthesia although onset of analgesia is earlier with spinal anaesthesia. Patients with ilioinguinal iliohypogastric nerve block ambulate earlier and have short hospital stay than patients with spinal anaesthesia Thus our study demonstrated that ilioinguinal iliohypogastric nerve block is superior to spinal anaesthesia for post-operative analgesia.