Ultrasound-guided peripheral nerve radiofrequency ablation for craniofacial postherpetic neuralgia: efficacy and safety in a retrospective cohort.

BACKGROUND

Craniofacial postherpetic neuralgia (PHN), though relatively uncommon, presents significant clinical challenges through chronic headache and facial pain manifestations. This study aimed to assess the efficacy of ultrasound-guided peripheral nerve radiofrequency ablation (RFA) for craniofacial zoster-related pain.

METHODS

A total of 91 patients with cephalofacial PHN admitted to the Renmin Hospital of Wuhan University from January 2023 and December 2024 were retrospectively analyzed. All patients were treated with ultrasound-guided peripheral nerve (supraorbital, infraorbital, mental, and greater occipital nerves) RFA. Pain intensity, sleep quality, and quality of life were objectively quantified using standardized metrics: Visual Analog Scale (VAS) for nociceptive assessment, 5-item validated questionnaire for sleep evaluation, and 36-Item Short Form Health Survey (SF-36) for multidimensional functional analysis. Both pharmacological protocols and post-RFA complications were systematically documented.

RESULTS

RFA demonstrated significant therapeutic outcomes: VAS scores decreased from 6.7 ± 1.0 to 2.2 ± 1.3 (p < 0.001), accompanied by SF-36 improvement and enhanced sleep quality (6.0 ± 3.4 vs. 10.7 ± 2.4; p < 0.001). Medication requirements substantially reduced, with pregabalin decreasing from 292 ± 74 mg to 70 ± 91 mg and tramadol from 163 ± 61 mg to 38 ± 63 mg (both p < 0.001). Postoperative complications analysis (n = 64) revealed cutaneous hypoesthesia as the most prevalent (82.8 %, 53/64), followed by puncture-site edema (57.8 %, 37/64). Less frequent occurrences included periorbital ecchymosis (15.6 %, 10/64), de novo neuralgia (7.8 %, 5/64), transient visual disturbances (4.7 %, 3/64), and localized infections (3.1 %, 2/64).

CONCLUSION

Ultrasound-guided peripheral nerve RFA effectively alleviates craniofacial zoster-related pain with concomitant improvements in quality of life and sleep metrics, though sustained vigilance regarding long-term sequelae remains clinically imperative.