[Efficacy, side effects and patient satisfaction with wrist conduction block anaesthesia prior to the treatment of palmar hyperhidrosis with botulinum toxin type A].
BACKGROUND
The treatment of palmar hyperhidrosis with botulinum toxin type A (BTX A) injections is one of the most effective therapeutic options. However, without adequate anaesthesia this treatment is not feasible in most patients. The anaesthesia of the radial, median and ulnar nerves (wrist block) is despite the absence of good data considered effective but risky.


METHODS
Between 1.10.1999 and 30.9.2001 retrospectively the efficacy, side effects and the patient satisfaction regarding the overall performance of the wrist block prior to the treatment of the palmar hyperhidrosis with BTX A was investigated. The study took place at the department of dermatology in Mannheim.


RESULTS
Of the 38 patients treated, 33 were finally included into the trial. The patients chose the average score of 7,9 +/- 2,1 (sd) on a scale from "0" to "10" (not at all effective--maximally effective) for the efficacy of the wrist block in reducing pain. The patients were very content with the wrist block and granted it the average score of 7,7 +/- 2,1 (sd) on a scale from "0" to "10" (not at all content--maximum content). Unwanted effects could be seen in 31/33 patients (93,9%): these were dizziness, headache or haematoma at the spot of injection as well as pain caused by the injections of the local anaesthesia or paresthesias such as tickling of the hand or arm. All side effects caused by the wrist block were reversible and lasted--except in one patient--only for a short time. 29/33 patients (87,9%) recommended the wrist block prior to treating palmar hyperhidrosis with BTX A and 28/33 patients (84,9%) could not imagine to agree to such a treatment without local anaesthesia.


CONCLUSIONS
The wrist block effectively reduces pain due to the treatment of palmar hyperhidrosis with BTX A. Major side effects are rare; patient acceptance and satisfaction are high.
Siebert
Thorsten
T
Klinik für Dermatologie, Venerologie und Allergologie, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Universitätsklinikum Mannheim.
Sinkgraven
Ronald
R
Fuchslocher
Monika
M
Rzany
Berthold
B
D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006945:Hyperhidrosis / Q000150:complications / Q000188:drug therapy*; D008297:Male; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011379:Prognosis; D016896:Treatment Outcome; D014953:Wrist / Q000294:innervation*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A