Abstract
INTRODUCTION: Ilioinguinal neuralgia is a commonly underdiagnosed and often refractory cause of chronic groin and lower abdominal pain. This technical report outlines an ultrasound-guided radiofrequency ablation (RFA) technique for ilioinguinal nerve (IIN) pain, summarizing key anatomical considerations to enhance procedural accuracy. TECHNIQUE: Anatomical studies show that the IIN most commonly arises from L1 and traverses between the internal oblique and transversus abdominis muscles within 1-2 cm of the anterior superior iliac spine (ASIS). Under ultrasound guidance, an 18-22-gauge radiofrequency cannula is advanced into the interfascial plane to target the IIN. Sensory stimulation is used to elicit the patient's typical symptoms, while motor testing confirms the absence of distal muscle activation. A diagnostic block is performed before lesioning. Continuous RFA is then applied at 80 °C for 60-90 s with additional lesions placed as needed based on anatomical variation. DISCUSSION: Previous published data demonstrate significant pain reduction and sustained benefits following ilioinguinal RFA, with improved function and minimal complications. Ultrasound-guided probe placement and stimulation testing enhance the reproducibility, accuracy, and safety of the procedure. CONCLUSIONS: Ultrasound-guided RFA of the IIN offers a minimally invasive treatment option for patients with refractory ilioinguinal neuralgia. Recognizing anatomical variability and utilizing stimulation testing, along with real-time imaging, can help clinicians improve the consistency of outcomes and reduce complications.