Lateral Femoral Cutaneous Nerve Radiofrequency Ablation for Meralgia Paresthetica: A Description of a Novel Technique

Meralgia paresthetica (MP) is neuropathic pain in the anterolateral thigh, most often caused by compression or injury to the lateral femoral cutaneous nerve (LFCN). Conservative treatments include weight loss, avoidance of compressive clothing, medical management with anti-inflammatory and neuropathic agents, and corticosteroid injections. For patients with MP refractory to these measures, radiofrequency ablation (RFA) is a minimally invasive option that may provide pain relief. This article introduces a novel ultrasound-guided continuous RFA technique designed to create a controlled thermal lesion of the LFCN, along with preliminary clinical outcomes. Pronounced anatomic variation of the LFCN at the anterior superior iliac spine makes real-time imaging essential for procedural accuracy, with ultrasound offering consistent nerve visualization and precise needle placement. Continuous RFA has demonstrated substantial and durable reductions in VAS scores, whereas pulsed RFA provides shorter-term relief with a favorable safety profile, and cooled RFA produces broader lesions that may help address anatomical variability, although supporting evidence is limited. Overall, RFA can be an effective treatment for MP refractory to conservative therapy, with optimal results dependent on detailed anatomical knowledge and accurate image guidance, particularly when using the novel continuous RFA approach described in this study.