Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction

Rakhshanda Layeeque, Julio Hochberg, Eric Siegel, Kelly Kunkel, Julie Kepple, Ronda S. Henry-Tillman, Melinda Dunlap, John Seibert, Vicki Klimberg, Luis O. Vasconez, Rakhshanda Layeeque, David W. Easter, Keith A. Kelly

Research output: Contribution to journalArticle

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Abstract

Introduction: We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction. Methods: An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the χ2 test for nominal level data to test for significance. Results: Forty-eight patients were entered into the study; 22 (46%) with and 26 (54%) without BT infiltration. Groups were comparable in terms of age (55 ± 11 years versus 52 ± 10 years; P = 0.46), bilateral procedure (59% versus 61%; P = 0.86), tumor size (2 ± 2 cm versus 2 ± 3 cm; P = 0.4), expander size and volume (429 ± 119 mL versus 510 ± 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 ± 1 versus 7 ± 2; P < 0.0001), during initial (score of 2 ± 2 versus 6 ± 3; P = 1.6 × 10-6), and final expansion (1 ± 1 versus 3 ± 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 ± 1 versus 7 ± 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 ± 10 mg versus 3 ± 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications. Conclusion: Muscular infiltration of botulinum toxin for mistake-tuum and tissue expander placement significantly reduced postoperative pain and discomfort without complications.

Original languageEnglish (US)
Pages (from-to)608-614
Number of pages7
JournalAnnals of Surgery
Volume240
Issue number4
DOIs
StatePublished - Oct 2004
Externally publishedYes

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Botulinum Toxins
Mastectomy
Pain
Tissue Expansion Devices
Postoperative Pain
Nonparametric Statistics
Rectus Abdominis
Research Ethics Committees
Myalgia
Narcotics
Spasm
Thoracic Wall
Visual Analog Scale
Prospective Studies
Control Groups

ASJC Scopus subject areas

  • Surgery

Cite this

Layeeque, R., Hochberg, J., Siegel, E., Kunkel, K., Kepple, J., Henry-Tillman, R. S., ... Kelly, K. A. (2004). Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. Annals of Surgery, 240(4), 608-614. https://doi.org/10.1097/01.sla.0000141156.56314.1f

Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. / Layeeque, Rakhshanda; Hochberg, Julio; Siegel, Eric; Kunkel, Kelly; Kepple, Julie; Henry-Tillman, Ronda S.; Dunlap, Melinda; Seibert, John; Klimberg, Vicki; Vasconez, Luis O.; Layeeque, Rakhshanda; Easter, David W.; Kelly, Keith A.

In: Annals of Surgery, Vol. 240, No. 4, 10.2004, p. 608-614.

Research output: Contribution to journalArticle

Layeeque, R, Hochberg, J, Siegel, E, Kunkel, K, Kepple, J, Henry-Tillman, RS, Dunlap, M, Seibert, J, Klimberg, V, Vasconez, LO, Layeeque, R, Easter, DW & Kelly, KA 2004, 'Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction', Annals of Surgery, vol. 240, no. 4, pp. 608-614. https://doi.org/10.1097/01.sla.0000141156.56314.1f
Layeeque R, Hochberg J, Siegel E, Kunkel K, Kepple J, Henry-Tillman RS et al. Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. Annals of Surgery. 2004 Oct;240(4):608-614. https://doi.org/10.1097/01.sla.0000141156.56314.1f
Layeeque, Rakhshanda ; Hochberg, Julio ; Siegel, Eric ; Kunkel, Kelly ; Kepple, Julie ; Henry-Tillman, Ronda S. ; Dunlap, Melinda ; Seibert, John ; Klimberg, Vicki ; Vasconez, Luis O. ; Layeeque, Rakhshanda ; Easter, David W. ; Kelly, Keith A. / Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction. In: Annals of Surgery. 2004 ; Vol. 240, No. 4. pp. 608-614.
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abstract = "Introduction: We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction. Methods: An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the χ2 test for nominal level data to test for significance. Results: Forty-eight patients were entered into the study; 22 (46{\%}) with and 26 (54{\%}) without BT infiltration. Groups were comparable in terms of age (55 ± 11 years versus 52 ± 10 years; P = 0.46), bilateral procedure (59{\%} versus 61{\%}; P = 0.86), tumor size (2 ± 2 cm versus 2 ± 3 cm; P = 0.4), expander size and volume (429 ± 119 mL versus 510 ± 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 ± 1 versus 7 ± 2; P < 0.0001), during initial (score of 2 ± 2 versus 6 ± 3; P = 1.6 × 10-6), and final expansion (1 ± 1 versus 3 ± 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 ± 1 versus 7 ± 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 ± 10 mg versus 3 ± 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications. Conclusion: Muscular infiltration of botulinum toxin for mistake-tuum and tissue expander placement significantly reduced postoperative pain and discomfort without complications.",
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AU - Layeeque, Rakhshanda

AU - Hochberg, Julio

AU - Siegel, Eric

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AU - Kepple, Julie

AU - Henry-Tillman, Ronda S.

AU - Dunlap, Melinda

AU - Seibert, John

AU - Klimberg, Vicki

AU - Vasconez, Luis O.

AU - Layeeque, Rakhshanda

AU - Easter, David W.

AU - Kelly, Keith A.

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N2 - Introduction: We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction. Methods: An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the χ2 test for nominal level data to test for significance. Results: Forty-eight patients were entered into the study; 22 (46%) with and 26 (54%) without BT infiltration. Groups were comparable in terms of age (55 ± 11 years versus 52 ± 10 years; P = 0.46), bilateral procedure (59% versus 61%; P = 0.86), tumor size (2 ± 2 cm versus 2 ± 3 cm; P = 0.4), expander size and volume (429 ± 119 mL versus 510 ± 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 ± 1 versus 7 ± 2; P < 0.0001), during initial (score of 2 ± 2 versus 6 ± 3; P = 1.6 × 10-6), and final expansion (1 ± 1 versus 3 ± 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 ± 1 versus 7 ± 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 ± 10 mg versus 3 ± 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications. Conclusion: Muscular infiltration of botulinum toxin for mistake-tuum and tissue expander placement significantly reduced postoperative pain and discomfort without complications.

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