Local neural block at the wrist for treatment of palmar hyperhidrosis with botulinum toxin: technical improvements
Journal of Drugs in Dermatology , Nov-Dec, 2004
Wrist blockage of median and ulnar nerves before treatment of palmar hyperhidrosis with botulinum toxin (BTX-A) reduces discomfort and improves accuracy of BTX-A injections. The authors state that wrist block increases accuracy but may be associated with mechanical/chemical injury. The present local anesthesia of the median/ulnar nerves using 25-G X 0.50 X 13 mm gauge needle compared to a short 30-G X 0.40 X 6 mm gauge needle. There were a total of 37 patients with hyperhidrosis; they were treated with BTX-A after median and ulnar nerve blockage. Eighteen patients had their nerve block performed with 25-gauge and 19 patients used the short 30-gauge. Both groups were evaluated for lag phase and anesthetic effect. None of the patients had pain or marked lag phase differences, and BTX-A injections were successfully applied.
JDD ARTICLE EVALUATION:
In hyperhidrosis the main deterrent to treatme5nt with Botox-A is pain due to injections. Hyperhidrosis is a cosmetically unpleasant condition for patients and Botox-A seems to be a long term, effective treatment. The authors compare a 25-G needle versus a 30-G needle for nerve blocks of the wrist prior to Botox-A injections in the hand. They demonstrated no difference in anesthetic effects on the tested patients and by demonstrating this provided a newer less painful technique to perform wrist blocks.
Campanati A, et al. J Am Acad Dermatol 2004; 51(3):345-8.
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