@KalagaraHari @jon_bailey_anes @jeffgadsden @amit_pawa @GongGasGirl @ASRA_Society @EMARIANOMD @BridgetPulos @fuzzymittens @mswami001 @Duke_Anesthesia @zedunow @dr_rajgupta @ankeetudani @anesthesianews @ajrmacfarlane @rosie_hogg @Nadia_Hdz_MD @anesthesiadocmd @docmorne @MKwesiKwofie @VeenaGraffMD @galusweegie @Jennythatcanbl1 @lipidguy @PeterMerjavy @bobfunn @DrRobbieErskine @James_Kim_MD @dr_tgro @SreeHPraveenKO1 @mjoldman @shanercpower @pritanand @DrEAlbrecht @ashwani_doc @AminaBenyoucef5 @acopand @L_D_White @AoraIndia @CAS_RegAnes @Ropivacaine @garrettsbarry @NarouzeMD @DrRiteshRoy1 @DrDiveshArora @anesthetix @tsmurali @kaohesham @Steve_Coppens Difficult. Multiple peripheral nerves involved. Balance of risk/benefit. Sometimes a controlled GA is the answer, or a single shot spinal, or a lumbar plexus, or multiple peripheral nerves, or ketamine +local by surgeon. No great options, tight sphyncter regardless of choice.