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Journal of the American Academy of Dermatology
Volume 63, n° 3
pages 466-474 (septembre 2010)
Doi : 10.1016/j.jaad.2009.10.034
Dermatologic Surgery

Bilateral forearm intravenous regional anesthesia with prilocaine for botulinum toxin treatment of palmar hyperhidrosis
 

Sofia Bosdotter Enroth, MD a, Alma Rystedt, MSc b, Lucian Covaciu, MD c, Kristina Hymnelius, BSc b, Einar Rystedt, MD a, Rebecka Nyberg, BSc d, Hans Naver, MD, PhD b, Carl Swartling, MD, PhD a,
a Department of Medical Science, Dermato-Venereology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden 
b Department of Neuroscience, Neurology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden 
c Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University Hospital, Uppsala University, Uppsala, Sweden 
d Department of Neuroscience, Clinical Neurophysiology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden 

Reprint requests: Carl Swartling, MD, PhD, Sophiahemmet, Box 5605, SE-114 86 Stockholm, Sweden.
Abstract
Background

Treatment of palmar hyperhidrosis with botulinum toxin (BTX) requires effective anesthesia, but previous methods have not provided enough pain relief or have resulted in a prolonged impaired hand function.

Objective

This is a study of bilateral forearm intravenous regional anesthesia using prilocaine for BTX treatment of palmar hyperhidrosis.

Methods

In all, 166 patients (100 female and 66 male) were treated bilaterally with intracutaneous BTX type A injections using intravenous regional anesthesia with prilocaine (5 mg/mL). In a subgroup of patients, forearm nerves were studied with neurophysiologic methods and blood concentrations of prilocaine were measured. Pain evaluation with a visual analog scale was accompanied with a questionnaire about the treatment.

Results

In all, 95% of the patients answering the questionnaire (response rate 89%) were satisfied with the anesthetic effect. No serious adverse events occurred. There was a fast recovery of motor function (in median 6 minutes) and sensory function (in median 20 minutes). No subclinical signs of sensory nerve damage were found.

Limitations

Recall and reporting bias are potential sources of limitations in this study.

Conclusion

Bilateral forearm intravenous regional anesthesia provides an effective and well-tolerated anesthesia during BTX treatment of palmar hyperhidrosis.

The full text of this article is available in PDF format.

Key words : botulinum toxin, hyperhidrosis, intravenous regional anesthesia, prilocaine

Abbreviations used : BTX, IVRA, SNAP, VAS



 Funding sources: None.
 Conflicts of interest: None declared.



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