TY - JOUR
T1 - Botulinum toxin infiltration for pain control after mastectomy and expander reconstruction
AU - Layeeque, Rakhshanda
AU - Hochberg, Julio
AU - Siegel, Eric
AU - Kunkel, Kelly
AU - Kepple, Julie
AU - Henry-Tillman, Ronda S.
AU - Dunlap, Melinda
AU - Seibert, John
AU - Klimberg, V. Suzanne
AU - Vasconez, Luis O.
AU - Layeeque, Rakhshanda
AU - Easter, David W.
AU - Kelly, Keith A.
PY - 2004/10
Y1 - 2004/10
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.
AB - 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.
UR - https://www.scopus.com/pages/publications/4644372324
UR - https://www.scopus.com/pages/publications/4644372324#tab=citedBy
U2 - 10.1097/01.sla.0000141156.56314.1f
DO - 10.1097/01.sla.0000141156.56314.1f
M3 - Article
C2 - 15383788
AN - SCOPUS:4644372324
SN - 0003-4932
VL - 240
SP - 608
EP - 614
JO - Annals of surgery
JF - Annals of surgery
IS - 4
ER -