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Can anyone help with this? I'm a women's health physio, so more of a dabbler in musculoskeletal/neuro work and this one is way beyond me. A woman in her late 30s, qualified nurse (learning disabilities/ challenging behaviour), severe asthmatic has surgery for an ovarian cyst. She has had a bad experience with spinal anaesthetics in the past so was given a GA with an abdominal wall block for the operation. This consisted of infiltration at 6 points, two for ilioinguinal nerves, two for rectus sheath and two subcutaneous. The surgery itself was completely uneventful. The surgeon had expected it might be difficult because she has had some pelvic and vaginal surgery in the past, but the cyst 'popped out' without difficulty. Immediately postoperatively she had severe weakness and sensory loss in obturator and femoral nerve distributionsof her left lower limb. Not assessed in detail - everyone expected it to wear off. But it didn't. Now at 17 weeks post op she has severe burning pain over mons pubis and anteriorly down thigh to knee. This began about 3 weeks post op. This is partially helped by carbemazepine and oromorph. She has no discernible activity in gracilis or hip adductors. Gross wasting and loss of activity in extensor digitorum brevis. Sensory loss in ilioinguinal, obturator and deep peroneal distribution. She walks with great difficulty with a stick, poor hip stability and unable to control abduction, also partial foot drop, sufficient to cause her to trip frequently. She has difficulty dressing, manoevring round objects, performing even minor household tasks. She has children (youngest age 4) and can't look after them properly. She cannot work, and her sick pay will run out in a few weeks. She is fairly desperate and looking to me for answers. The surgeon and anaesthetist are completely puzzled as to why this has happened. The nerve block was very superficial, could not possibly have come near the obturator nerve (especially not proximal to its division). anyway, nerve block usually wears off. She has consulted a neurologist, who didn't examine her, ordered sensory and motor studies of sural and peroneal nerves and emg of Tib ant, vastus medialis, triceps surae and ext. dig. brevis which found nothing untoward. (?why didn't he ask for adductors?). He also told her that the problem is 'in the brain' and that the intense neurogenic pain is 'postural'. He also dismissed the physio assessment ( done by one of my most expert musculoskeletal colleagues) as irrelevant. This unfortunate woman is desperate to return to work and a normal life. There is no explanation and no prognosis. Can anyone suggest what has happened? And why the mysterious distribution? And can anyone suggest a neurologist (or any other specialist?) in the UK (Midlands or North of England) who might be able to give an intelligent second opinion? Many thanks to anyone who can shed some light. Bardy