Targeted Cooled Radiofrequency Ablation for Chronic Postoperative Scar Neuralgia of the Anterior Abdominal Wall: A Case Report

Abstract This case report aims to present a case of scar neuralgia of the anterior abdominal wall, which was treated with cooled radiofrequency (RF) ablation. Scar neuralgia is a clinically significant but often under-recognized type of neuropathic pain arising from scar-associated nerve injury or nerve entrapment following surgery or trauma. It can affect the quality of life of the patient due to the nature of the pain. A multidisciplinary strategy tailored to the underlying mechanism and severity of nerve involvement is needed for its management. A 64-year-old female presented with chronic pain of 40 years over a postoperative scar on the anterior abdominal wall. After failure of pharmacological management, a diagnostic nerve block was performed, which provided her temporary relief, confirming scar neuralgia. Ultrasound-guided pulsed RF ablation was attempted but was deferred due to lack of sensory response. She then was subjected to cooled RF ablation of the targeted nerve under ultrasound guidance. She experienced significant pain relief during follow-up. Cooled RF ablation provides an effective and promising modality due to the creation of larger and more uniform lesions for the treatment of refractory scar neuralgia in cases of non-localization of a neuroma. As the use of cooled RF ablation for scar neuralgia of the anterior abdominal wall is an area with limited published evidence, this case report contributes to its therapeutic potential and supports the need for further research and trials.