Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin

Yi, Kyu‐Ho; Lee, Ji‐Hyun; Hu, Hyewon; Kim, Jin-Hyun; Park, Hyunjun; Kim, K. M.; Kim, Jihyo; Kim, Hee‐Jin

doi:10.1007/s00276-023-03199-4

Cited by 1 publication

(1 citation statement)

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“…In particular, compelling results have been achieved with the median nerve block in a recent study, demonstrating that local block significantly reduces pain during multiple injections of BoNT for treating focal HP. The study also recommends that the optimal site for local anesthesia injection should be located 4 cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles [ 31 ]. However, these methods are often poorly tolerated by patients and demand precision from the administering physician.…”

Section: Introductionmentioning

confidence: 99%

Pain Control during the Treatment of Primary Palmar Hyperhidrosis with Botulinum Toxin A by a Topical Application of Liposomal Lidocaine: Clinical Effectiveness

Marani,

Gioacchini,

Paolinelli

et al. 2024

Toxins

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Primary palmar hyperhidrosis (PPH) constitutes a debilitating condition that profoundly impacts the social, functional, and occupational aspects of individuals. The intradermal administration of botulinum toxin type A (BoNT-A) stands as an established therapeutic approach for PPH, albeit one frequently accompanied by considerable pain, posing challenges for patient tolerance. Our study aimed to assess the efficacy of combining cryoanalgesia spray (CA) with topical anesthesia utilizing a cream containing liposomal lidocaine at a concentration of 40 mg/g, with the objective of mitigating the pain associated with intradermal BoNT-A injection for PPH treatment. Nineteen participants, aged ≥18 years and afflicted with severe PPH, were enrolled in a double-blind randomized vehicle-controlled trial. Patient-perceived pain during the procedure was quantified using the Numeric Rating Scale (NRS). Statistical analysis was applied to the collected data. The combination of CA and the topical application of liposomal lidocaine during BoNT-A treatment for PPH resulted in diminished pain compared to CA alone and the combination of CA with the application of a basic cream. Topical anesthesia through the application of a liposomal lidocaine-containing cream emerged as a facile, secure, and efficacious approach for alleviating the pain associated with intradermal BoNT-A injection in PPH treatment. Furthermore, it demonstrated compatibility with CA, thereby offering a comprehensive strategy for pain management during BoNT-A administration.

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Section: Introductionmentioning

confidence: 99%