Reconstituting botulinum toxin A with bupivacaine is safe, does not limit efficacy, and does not reduce the degree or relative duration of muscular paralysis. Reconstituting botulinum toxin A with bupivacaine results in faster onset of paresis, possibly due to a synergistic effect of bupivacaine induced myotoxicity. Utilizing bupivacaine may result in less pain for patients.
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