title: A Novel Use of Regional Anesthesia for Spastic Hemiplegia Evaluation and Treatment: A Case Report.
abstract: Spastic hemiplegia is a common sequela of stroke. Spasticity that is not optimally reduced with systemic therapy is often treated with intramuscular botulinum toxin injections. Spastic tone can increase the difficulty of appropriately positioning the patient for botulinum toxin injections, lengthen procedure duration, and increase periprocedural pain. Our patient, a 53-year-old woman, was unable to be adequately positioned to receive botulinum toxin injections to her left upper extremity because of challenging flexion synergy posturing and related positional pain. A left interscalene brachial plexus local anesthetic block administered under ultrasound guidance was used to produce both temporary dense muscle relaxation and profound anesthesia, facilitating successful and comfortable botulinum toxin injections in this patient.
authors.affiliation: Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, TX(∗)(†).
authors.forename: Ameet S
authors.initials: AS
authors.lastname: Nagpal
authors.affiliation: Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, TX(∗)(†).
authors.forename: Maxim S
authors.initials: MS
authors.lastname: Eckmann
authors.affiliation: Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr (MC 7843), San Antonio, TX 78229-3900(‡). Electronic address: benfield@uthscsa.edu.
authors.forename: Jon
authors.initials: J
authors.lastname: Benfield
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D065527:Brachial Plexus Block; D005260:Female; D006429:Hemiplegia / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D020521:Stroke / Q000150:complications*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A