Ultrasound-guided neuromodulation for neuropathic pain after radial forearm flap reconstruction: a case report

Neuropathic pain is a common complication following radial forearm free flap (RFFF) reconstruction, often associated with damage to the superficial branch of the radial nerve (SBRN) and lateral antebrachial cutaneous nerve (LACN). Traditional treatment approaches, including pharmacologic and non-pharmacologic interventions, frequently provide incomplete pain relief. This case report describes the innovative use of ultrasound-guided musculocutaneous and SBRN blocks combined with pulsed radiofrequency (PRF) neuromodulation in a 70-year-old male with severe neuropathic pain following RFFF for tongue carcinoma reconstruction. The intervention provided immediate and complete pain relief, maintained for three days post-procedure. Partial symptom improvement persisted beyond the initial phase. Although complete pain relief was not sustained over the longer term, the significant initial response confirmed the targeted nerves as viable candidates for neuromodulation. This confirmation opens potential pathways for exploring longer-lasting neuromodulation techniques, such as cryoneurolysis or peripheral nerve stimulation, to achieve sustained pain relief. Further research into these modalities is recommended to optimize long-term outcomes for patients experiencing neuropathic pain post-RFFF reconstruction.