[Ultrasound-guided pulsed and thermal radiofrequency in a patient with neuropathic pain after total ankle arthroplasty: a clinical case].

Radiofrequency ablation (RF), in its pulsed and thermal modalities, is a minimally invasive technique for managing refractory chronic neuropathic pain. We present the case of a 60-year-old woman with persistent pain in her left ankle following avascular necrosis of the talus treated with total ankle arthroplasty. This surgical intervention can lead to complications such as postoperative neuropathic pain, with an incidence that can vary between 10% and 20%. Despite physiotherapy and electrotherapy, she maintained a VAS score of 8 and a DN4 score of 7. A diagnostic block of the superficial peroneal and sural nerves provided temporary relief, so pulsed RF (65V, 4min) was performed on the superficial peroneal nerve and thermal RF (80°C, 90s) on the sural nerve, both under ultrasound guidance. Subsequently, both nerves were infiltrated with 1cc of betamethasone, 2cc of mepivacaine, and 2cc of saline solution to prevent pain after the procedure. At two weeks, the patient presented with a resting VAS score of0, an active VAS score of3, and a DN4 score of2, with sustained improvement at one month and 6months, with increased functionality. This case suggests the value of RF as a safe and effective alternative for postoperative neuropathic pain resistant to conventional therapies. The objective is to present a representative case of the interventional management of neuropathic pain using radiofrequency, with emphasis on patient selection, technique, highlighting safety considerations and reviewing the available evidence.