Inguinal hernia is a common and frequent disease in general surgery, there are about 2 million cases of such patients in China every year, and only about 30,000 patients receive tension-free hernia repair surgery every year. The inguinal hernia patients’ muscles, tendons and ligaments and other fibrous connective tissues have different degrees of degenerative changes, at the same time, the transversal abdominal fascia is flaccid and thin, and there are many damage defects in the inner ring, coupled with often suffer from diseases that lead to sustained increase in intra-abdominal pressure, such as chronic bronchitis, pulmonary heart disease, prostatic hyperplasia, habitual constipation and obesity, etc., so that the prevalence of extra-abdominal hernias has always been high. Reasonable inguinal hernia repair should be high free ligation of the hernia sac, according to the anatomical level of repair, to restore the normal physiological and anatomical function of the inguinal area. Traditional surgery requires extensive intraoperative detachment, large losses, and forcible suturing of different tissues together to strengthen the inguinal wall, which destroys the original physiological and anatomical structure, and results in significant postoperative pain, prolonged bed rest, and susceptibility to pulmonary infections and thrombosis. A large number of cases show that the recurrence rate of tension-free hernia repair in the primary hernia is only 0.1%, recurrent hernia is 2%, known as the 21st century hernia surgery “milestone”. The use of Lichtenstein’s surgical patch replaces the traditional surgery of forcibly sewing different tissues together, so the patient has no obvious postoperative pain and pulling sensation, and there is no obvious localized bulging phenomenon. Patients can get out of bed within 1 day after surgery and return to normal activities within 1 week, which significantly reduces the bedtime compared with traditional surgery. Many patients with inguinal hernia, especially the elderly patients are often combined with different degrees of heart, brain, lung and other chronic diseases, epidural or general anesthesia is more risky. Local anesthesia does not have epidural anesthesia and general anesthesia on the systemic hemodynamic effects and toxic side effects. Local anesthetics broaden the indications and improve the safety of hernia repair. The Lichtenstein procedure does not disturb the physiologic anatomy of the inguinal region, the patch is rapidly fixed to the graft site, and the pain and discomfort caused by intraoperative straining is less severe. Tissue anesthesia of the iliohypogastric, ilioinguinal, and genitofemoral nerves provides complete coverage of the Lichtenstein area. The slow absorption and metabolism of the local anesthetic reduces postoperative wound pain. Lichtenstein repair under local anesthesia need to pay attention to: (1) preoperative psychological comfort is very necessary. Obtaining the patient’s trust and understanding of anesthesia and surgery can relieve the patient’s nervousness and increase confidence in accepting the operation, and communication with the patient should be continued until the end of the operation. (2) Intensive cardiac and electrical monitoring during and after surgery: the elderly often have combined heart, brain, lung and other diseases, so the relevant examinations and preoperative preparations should be perfected before surgery, and intensive cardiac and electrical monitoring should be carried out during and after surgery. (3)Local anesthesia operation should follow the principle of combining subcutaneous, intracutaneous, sub-tendinous membrane of external abdominal oblique muscle and nerve block under direct vision, the operation should be precise, and should be adjusted according to the patient’s feeling under the premise of controlling the total amount of anesthesia drug during the operation. (4) The cutting and suture fixation of the patch must be standardized. (5) Try to arrange experienced physicians to perform the operation, which can reduce unnecessary stimulation and injury and shorten the operation time. In summary, Lichtenstein’s surgery under local anesthesia to repair inguinal hernia is more in line with the patient’s anatomy and physiology, and has the advantages of firm repair, low recurrence rate, small trauma, easy to tolerate, fast recovery, low complications, less cost, high satisfaction of patients and families, and in line with the internationally popular evaluation indexes, etc., which is a kind of safe, reliable, simple and economic inguinal hernia repair method.