Effective local anesthesia for onabotulinumtoxin A injections to treat hyperhidrosis associated with traumatic amputation.
BACKGROUND
Botulinum toxin type A (BTX-A) injections are an effective treatment for controlling hyperhidrosis at sites of amputation. Hyperesthesia associated with amputated limbs is a major barrier to performing this procedure under local anesthesia.


OBJECTIVE
To present a novel method for improving local anesthesia with BTX-A injections. Methods &amp;


RESULTS
A 29-year-old military veteran with a below-the-knee amputation of his right leg was suffering from amputation site hyperhidrosis, which was impeding his ability to comfortably wear a prosthesis. Prior to presenting to our clinic, the patient received one treatment of BTX-A injections to his amputation stump while under general anesthesia for surgical repair of trauma-related injuries. In our dermatology clinic, we repeated the procedure using topical lidocaine-prilocaine (30 gm total) for local anesthesia. This provided effective relief of hyperhidrosis for 6 months, but the procedure was very painful (9/10 intensity). We repeated the same procedure 6 months later, using ice in addition to topical lidocaine-prilocaine (30 gm) for local anesthesia; this resulted in reduced pain (3/10 intensity) for the patient.


CONCLUSIONS
We suggest using ice in combination with a topical anesthetic as an effective method for pain control that avoids general anesthesia in treating amputation-associated hyperhidrosis.
Lucy L
LL
Shi
Emory University, Department of Dermatology, Atlanta, GA. michael.sargen@emory.edu.
Michael R
MR
Sargen
Suephy C
SC
Chen
Jack L
JL
Arbiser
Brian P
BP
Pollack
D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000279:Administration, Cutaneous; D000672:Amputation Stumps; D000673:Amputation, Traumatic / Q000150:complications; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D017679:Cryotherapy / Q000379:methods*; D006801:Humans; D006945:Hyperhidrosis / Q000188:drug therapy* / Q000209:etiology; D007271:Injections, Intradermal; D007868:Leg Dermatoses / Q000188:drug therapy*; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D011318:Prilocaine / Q000627:therapeutic use; D014728:Veterans; D055815:Young Adult
D065087:Acetylcholine Release Inhibitors; D000779:Anesthetics, Local; D011318:Prilocaine; D008012:Lidocaine; D019274:Botulinum Toxins, Type A