Treatment of Meralgia Paresthetica with Ultrasound‐Guided Pulsed Radiofrequency Ablation of the Lateral Femoral Cutaneous Nerve

Abstract

A 23-year-old female with an 18-month history of left anterolateral thigh paresthesias and burning pain consistent with meralgia paresthetica was referred to our clinic after failing trials of physical therapy, nonsteroidal anti-inflammatories, gabapentin, and amitriptyline. We performed 3 lateral femoral cutaneous nerve blocks with corticosteroid over a 4-month period; however, each block provided only temporary relief. As this pain was limiting the patient's ability to perform her functions as an active duty service member, we elected to perform a pulsed radiofrequency treatment of the lateral femoral cutaneous nerve with ultrasound guidance and nerve stimulation. After locating the lateral femoral cutaneous nerve with ultrasound and reproducing the patient's dysthesia with stimulation, pulsed radiofrequency treatment was performed at 42°C for 120 seconds. The needle was then rotated 180° and an additional cycle of pulsed radiofrequency treatment was performed followed by injection of 0.25% ropivacaine with 4 mg of dexamethasone. At 1.5 and 3 month follow-up visits, the patient reported excellent pain relief with activity and improved ability to perform her duties as an active duty service member. ▪

Painful Traumatic Neuromas in Subcutaneous Fat: Visibility and Morphologic Features With Ultrasound

“…To date, few studies have assessed the ability of US to guide treatment of subcutaneous nerve injuries. In their case report, Fowler et al described the treatment of meralgia paresthetica with US‐guided pulsed radiofrequency ablation of the lateral femoral cutaneous nerve. In a further single case study, Rhame et al reported the use of cryotherapy under US guidance in treating refractory sural neuroma.…”

“…Good visibility of subcutaneous nerves and associated neuromas may help pave the way for US‐guided percutaneous procedures, such as the ones used in patients with deeper and sensorimotor nerve stump syndrome, Morton neuroma, meralgia paresthetica, and carpal and tarsal tunnel syndromes. Phenol injection, alcohol ablation, corticosteroid injection, pulsed radiofrequency treatment, extracorporeal shock wave therapy, and cryoprobe treatment (cryoablation and cryoneurolysis) have been used with varying success rates. To date, few studies have assessed the ability of US to guide treatment of subcutaneous nerve injuries.…”

Anatomic variability of the lateral femoral cutaneous nerve: Value of 3T MRI in identifying anomaly for surgical intervention

“…The observation of this report, that the LFC crossing over the ASIS and iliac crest can be a clinical problem, has been noted recently in a woman whose nerve was observed on ultrasound to be markedly flattened and over the crest on the symptomatic side while in a position deep to the inguinal ligament on the asymptomatic side (Park, Kim, Hwang, & Bun, ). Ultrasound identification of the LFC has been well‐described (Bodner et al, ; Zhu et al, ), is usually used for guided nerve blocks (Hara, Sakura, & Shido, ; Vandebroek, Vertommen, & Huyghe, ), but has also been reported related to diagnosis of LFC entrapment (Aravindakannan, ; Fowler & Tucker, ).…”

Ultrasound guided chronic pain interventions (Part I)

“…[31] Fowler et al performed US guided PRF (42°C, 2x120 second) in a patient diagnosed with Meralgia Paresthetica who was unresponsive to various treatments. [32] They reported excellent pain relief in controls at 1.5 th and 3 rd month. Authors report US provides great convenience in identification of LFCN.…”