Intravenous regional anesthesia (Bier's block) for botulinum toxin therapy of palmar hyperhidrosis is safe and effective.
BACKGROUND
Botulinum toxin type A (BTX-A) has been shown to be highly effective in reducing palmar hyperhidrosis. Since palmar injections is a painful procedure, the use of an anesthesia method is recommended.


OBJECTIVE
To assess the efficacy of intravenous regional anesthesia (IVRA) for painless treatment of palmar hyperhidrosis with BTX-A compared to topical application of a local anesthetic agent.


METHODS
Thirty patients with palmar hyperhidrosis were treated with BTX-A injections, using a total dose of 100 U BTX-A for each hand. One palm was pretreated with a topical application of local anesthetizing cream (EMLA cream), while the other palm was anesthetized with IVRA. Sweat secretion was visualized with Minor's test and quantified by corneometer analysis before and after BTX-A therapy.


RESULTS
BTX-A therapy was significantly less painful in palms anesthetized with IVRA than in palms pretreated with EMLA cream (P < 0.0001, paired Wilcoxon rank test). Two weeks after the BTX-A injections, corneometer measurements showed that spontaneous sweat production had declined significantly, from 115 +/- 16.25 (left hand) and 114 +/- 17.58 (right hand) before therapy to 81.5 +/- 27.33 (left hand) and 74 +/- 28.08 (right hand) after therapy (P < 0.001, paired t test).


CONCLUSIONS
IVRA safely and effectively alleviates the pain associated with BTX-A treatment for palmar hyperhidrosis. Quantitative analysis with the corneometer showed that BTX-A significantly reduces sweat production. We conclude that IVRA is a suitable method for providing pain relief in the treatment of patients with palmar hyperhidrosis.
Blaheta
Hans-Juergen
HJ
Department of Dermatology, University of Tuebingen, Tuebingen, Germany.
Vollert
Barbara
B
Zuder
Daniel
D
Rassner
Gernot
G
D000328:Adult; D000771:Anesthesia, Intravenous / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000517:prevention & control*; D007271:Injections, Intradermal; D008012:Lidocaine / Q000008:administration & dosage; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D009824:Ointments / Q000008:administration & dosage; D011318:Prilocaine / Q000008:administration & dosage*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D009465:Neuromuscular Agents; D009824:Ointments; D011318:Prilocaine; D008012:Lidocaine; D019274:Botulinum Toxins, Type A