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


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


CONCLUSIONS
Bilateral forearm intravenous regional anesthesia provides an effective and well-tolerated anesthesia during BTX treatment of palmar hyperhidrosis.
Bosdotter Enroth
Sofia
S
Department of Medical Science, Dermato-Venereology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
Rystedt
Alma
A
Covaciu
Lucian
L
Hymnelius
Kristina
K
Rystedt
Einar
E
Nyberg
Rebecka
R
Naver
Hans
H
Swartling
Carl
C
D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods; D000771:Anesthesia, Intravenous; D001905:Botulinum Toxins / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm; D006225:Hand; D006801:Humans; D006945:Hyperhidrosis / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D017060:Patient Satisfaction; D010862:Pilocarpine / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
D010862:Pilocarpine; D001905:Botulinum Toxins