a 29-year - old woman , being artificially inseminated with twins , was hospitalized to get a cesarean section . a cesarean section was scheduled for her on the next day , but sudden pain and progression of the childbirth delivery forced her to the childbirth delivery room early . as she had undergone a vaginal delivery 3 years ago , after entering the operating room , the surgeons made the parturient woman take the lithotomy position to try a vaginal delivery again , but it was unsuccessful . spinal anesthesia was administered to the patient since she had spent only 5 hours fasting . the surgeons put the patient in the right lateral decubitus position and disinfected the puncture part between the l3-l4 spinous processes with betadine solution . then , the surgeons inserted 26 g quinke , a spinal needle , into the puncture part by the midline approach method to verify whether the cerebrospinalfluid ( csf ) would smoothly release . after seeing a smooth flow , the surgeons injected 10 mg of hyperbaric 0.5% bupivacaine and 20 g of fentanyl . during the insertion of the needle and injection of the drug , the mother did n't complain of any pains or paresthesia on her back and lower limbs . following the verification of the sensory blockade up to t6 thoracic vertebra 10 minutes after the drug injection , the surgeons began the operation for cesarean section . after the delivery , a hartmann solution containing 20 units of oxytocin was injected ; however , the vaginal contraction was still insufficient . therefore , the surgeons injected 0.2 mg of methylergometrine into her triceps brachialis muscle and 500 ml of normal saline containing 1 mg of sulprostone into her body at the rate of 100 ml per hour . thirty minutes after the delivery , when her blood pressure declined to 70/40 mmhg , 8 mg of ephedrine was injected , and her blood pressure returned to the normal level and stayed at 110/60 mmhg afterward . for the rest of the operation time , there was nothing unusual . following the operation , the mother was brought to the postanesthetic recovery unit to be observed for 1 hour . after the doctors found that her sensory blockade was maintained up to t12 thoracic vertebra and there was no abnormality , they decided to move the patient to her ward . two days after the operation , the anesthesiology department was asked for a joint treatment because the patient complained of numbness and paresthesia on her left leg . although the mother said that she had paresthesia on her left femoral region , the doctors could n't find any dyskinesia , decline in strength , lumbago , pooling of urine and feces , or paresthesia on the perineal region . the authors scanned her lumbar vertebrae with magnetic resonance imaging ( mri ) to verify epidural hematoma or abscess , but nothing unusual was discovered . the authors also conducted a blood test to determine infection and inflammatory condition , and obtained the result that her white blood cell ( wbc ) count was 6,400/l and erythrocyte sedimentation rate ( esr ) was 13 mm / hr , both of which are normal . subsequently , the authors decided to remain on the watch without additional treatment , considering that , according to neurological and laboratory tests , the patient had little possibility of nerve injury from spinal anesthesia , epidural hematoma , and abscess . however , after the patient continuously complained of the symptom for days , needle electromyography and nerve conduction studies were conducted on her truncus and lower limbs to identify any lesions in the nerve root and peripheral nerve . as a result , the sensory nerve conduction velocity ( sncv ) test discovered a left lateral cutaneous nerve injury while the needle electromyography study did n't find anything unusual ( fig . , the patient said that her symptom was reduced when her left pelvis was compressed . considering her symptom , which was limited to left lateral cutaneous nerve , and the result of the pelvic compression test , the authors diagnosed her as meralgia paresthetica and prescribed nonsteroidal anti - inflammatory drugs for conservative treatment . she was allowed discharge and was traced as an outpatient for a month . according to the result of the observance after discharge , the numbness on her left femoral region disappeared without special treatment , and complete blood cell count ( cbc ) and esr were also within normal levels . during pregnancy , skeletal muscles and ligaments of parturient women become relaxed , and , with the progress of pregnancy , uteri expand and lordoses of lumbar vertebrae increase . for those reasons , this can be attributed to the following accidents in the process of delivery or operation : neurotmesis , damage in kidneys or blood vessels , or compression . postpartum nerve injury often occurs to primiparas and is related to cephalopelvic disproportion and midforceps delivery . especially , it happens more frequently if primiparas have prolonged pains during their second stage of labor . the nerve injury mainly results from endogenous factors , whereas direct damage caused by regional anesthesia is rare . generally , neuraxial anesthesia is greatly favored to reduce pain during labor or to conduct a cesarean section . if parturient women show some neurotic symptoms after neuraxial anesthesia , doctors need to verify mass lesions , such as epidural hematoma or abscess . if diagnosis is delayed for more than 8 hours , the nerve injury can become permanent , thus early diagnosis and treatment is required . in this research , 2 days after the operation , when the patient complained of paresthesia on her left femoral region , unaccompanied by any decline in strength and pain , the authors administered an mri scan and blood test although epidural hematoma or abscess seemed unlikely . also , the authors reckoned that the possibility of cauda equina syndrome was low since there was no pooling of urine and feces , sense deprivation on the perineal region , or declined strength of the lower limbs . moreover , the author excluded the possibility of direct damage to spinal cords , cornus medullaris , and spinal nerve root because the patient did n't complain of any pain during the insertion of the spinal needle . then , the authors conducted needle electromyography and nerve conduction studies on the patient 's truncus and lower limbs since they suspected an endogenous nerve injury . as a result , the authors were able to exclude the possibility of radiculopathy since the needle electromyography showed a positive result . however , the nerve conduction study discovered a left lateral cutaneous nerve injury , leading the authors to diagnose meralgia paresthetica . after the series of tests , the patient fully recovered , along with conservative treatment and follow - up observation . the patient 's such experience was also in line with the development of meralgia paresthetica . meralgia paresthetica , which affects 4.3 out of 10,000 people annually , is a kind of peripheral nerve disorder and is caused by mononeuropathy of the lateral femoral cutaneous nerve . this disease can be characterized by numbness limited to the front femoral region , weakened response to a pinprick , pain , or the sensation of burning fire . generally , the symptom is temporary but hardly clear . the lateral femoral cutaneous nerve stretches from under the anterior iliac spine to the under the inguinal ligament . a lot of entrapments happen in this part of body and result in meralgia paresthetica . the examples of the former are mechanical factors that increase the pressure inside the stomach , such as obesity , pregnancy , tight clothes and belts , and pelvic benign tumors . meanwhile , diopathic reasons include pelvic osteotomy , orthopedic treatments including spinal surgeries , laparoscopic cholecystectomy , laparoscopic myomectomy , coronary artery bypass grafting surgery , aortic valve replacement surgery , and bariatric surgery for extreme obesity [ 8 - 10 ] . in this research , the authors thought that the meralgia paresthetica of the patient was caused by the increased intra - abdominal pressure due to pregnancy and labor , as well as the lithotomy position , which compressed the lateral femoral cutaneous nerve . meralgia paresthetica is diagnosed by physical examination such as a pelvic compression test , which determines whether specific clinical symptoms ( e.g. , numbness of front thigh and paresthesia ) and symptoms of the patient are improved when she is laid in the lateral decubitus position and her pelvis is pressed . if the patient has symptoms in bilaterality or complains of dyskinesia , and abnormal senses lead to distinct pain , other diseases that may cause sense paresthesia , such as a herniated intervertebral disk of the lumbar vertebra or radiculopathy , should be detected . during a clinical examination in which it is difficult to clearly diagnosis the patient , the diagnosis can be confirmed by a neurophysiological test . it is known that almost all patients with meralgia paresthetica show abnormality in the sensory nerve conduction study of the lateral femoral cutaneous nerve . a neurophysiological test other than the sensory nerve conduction study , such as a somatosensory evoked potential , can be also helpful in diagnosis . in treatment , most patients with meralgia paresthetica fully recover ( nearly about 85% ) within 4 - 6 months with conservative treatment . as for conservative treatment , nonsteroidal anti - inflammatory drugs , tricyclic antidepressants , and anticonvulsants can help ease symptoms . in this casuistics , only conservative treatment brought about an improvement in the symptoms in times of diagnosing meralgia paresthetica , but in the case of severe symptoms , 1 ) local nerve block therapy that uses 0.25% of bupivacaine and corticosteroid or 2 ) ultrasound guidance block therapy on the lateral femoral cutaneous nerve are known as effective . a local steroid reduces excessive irritability of neurons and c - fibers . if those nerve block therapies do not work - though this would be a rare case - then operational decompression of the inguinal ligament , neurolysis of the lateral femoral cutaneous nerve , or transposition are recommended . nerve injury that the mother suffers after part of the regional anesthesia has been administered is not necessarily caused by the regional anesthesia but can be triggered by pregnancy , delivery , or the patient 's position during operation . however , as temporary nerve injury is not infrequent , anesthesiologists should differentiate post - delivery nerve injury from injury caused by neuraxial anesthesia , in order to prevent that patient from developing complications that can result in permanent disability .