Management of pain from skeletal metastases is notoriously difficult. Case reports and
case series have described radiofrequency ablation of the obturator nerve branches to the
femoral head for treatment of intractable hip pain. Ablation of the obturator branches to
the femoral head is technically difficult because of bony and vascular anatomy, including
close proximity of the femoral vessels. Here we present the case of a 79-year-old woman
with intractable right hip pain and inability to ambulate secondary to metastatic non-small
cell lung cancer in the femoral head and acetabulum, treated with thermal radiofrequency
ablation of the obturator and femoral nerve branches to the femoral head. Ablation of
the obturator nerve was done via anterior placement of the radiofrequency needle under
combined ultrasound and fluoroscopic guidance, passing the radiofrequency needle
between the femoral artery and femoral vein. Real-time ultrasound guidance was used to
avoid vascular puncture. Thermal radiofrequency ablation resulted in sustained pain relief,
and resumption in the ability of the patient to ambulate. From this case we suggest that an
anterior approach to the obturator nerve branches to the femoral head may be technically
feasible using combined ultrasound and fluoroscopic guidance to avoid vascular puncture.
Key words: Obturator nerve, radiofrequency ablation, cancer associated pain
Radiofrequency Ablation of the Trochanteric Branches of the Femoral Nerve for the Treatment of Greater Trochanteric Syndrome