A Novel Technique to Reduce Pain from Intradermal Injection of Botulinum Toxin Type A

Jung, Gyu Sik; Kim, Hyung Seok

doi:10.1097/gox.0000000000003417

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…They reported that the addition of lidocaine with epinephrine could provide the physician with immediate feedback on the extent of paralysis, and thus improve the predictability and safety of botulinum toxin 18 . As the closest study to our design in terms of the diluents of botulinum, Jung and Kim 28 examined the intensity of pain after the injection of botulinum toxin diluted with lidocaine plus sodium bicarbonate in 20 patients and found pain-decreasing effects for the lidocaine-bicarbonate complex 28 .…”

Section: Discussionmentioning

confidence: 99%

Effects of lidocaine incorporation (without epinephrine) on pain and 2-week complications of botulinum toxin: a double-blind randomized placebo-controlled clinical trial

Sarkarat,

Bagheri,

Kahali

et al. 2023

Sci Rep

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No study has assessed the effects of the incorporation of isolated lidocaine into botulinum toxin for reducing its pain or complications. Studies on the dilution of botulinum toxin with other materials are as well extremely few, small, and limited methodologically. Therefore, we aimed to evaluate, for the first time, the effects of the incorporation of lidocaine alone into botulinum toxin type A on post-injection pain and complications. In this 2-week prospective, multicenter, double-blind randomized placebo-controlled clinical trial, 729 participants (667 females) were enrolled. They were randomized into placebo and lidocaine dilutions (about 2:1), and then into two brands of toxins (Dysport versus Xeomin). Hence, there were 4 subgroups. In the 2 experimental subgroups, botulinum toxin was diluted with 2% lidocaine without adrenaline; in the 2 control subgroups, botulinum toxin was diluted with normal saline as a placebo. After injection, the pain level was recorded (as an 11-scale numerical rating scale from 0 to 10). After 2 weeks, post-injection complications were assessed based on the participants’ reports and the surgeon’s observations. Data were analyzed using 3-way ANCOVA, multiple binary logistic regression, and bivariable analyses (α = 0.05, β ≤ 0.1). The mean ± SD pain levels in the lidocaine group (n = 263) and the placebo group (n = 466) were 3.51 ± 2.04 and 4.15 ± 2.35, respectively. The mean ± SD pain levels in the subgroups ‘Xeomin-Lidocaine (n = 61), Dysport-Lidocaine (n = 202), Xeomin-Placebo (n = 133), and Dysport-Placebo (n = 333)’ were respectively 3.39 ± 1.86, 3.55 ± 2.09, 4.61 ± 2.49, and 3.97 ± 2.24. Lidocaine incorporation (P = 0.001), Dysport brand (P = 0.030), and younger age (P = 0.032) [but not sex (P = 0.406)] reduced pain. The only significant findings for 2-week complications were for the associations observed between aging with increased asymmetry (P = 0.022, OR = 1.032) and a need for a retouch (P = 0.039, OR = 1.021). Botulinum toxin dilution with lidocaine alone (without adrenaline or other ingredients) can reduce pain without affecting postinjection complications. Toxin brands may cause different extents of pain. Aging, but not sex, may increase pain. Two-week complications were not affected by any factors, except aging in the case of asymmetry and the need for a botulinum toxin retouch.

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Section: Discussionmentioning

confidence: 99%

Effects of lidocaine incorporation (without epinephrine) on pain and 2-week complications of botulinum toxin: a double-blind randomized placebo-controlled clinical trial

Sarkarat,

Bagheri,

Kahali

et al. 2023

Sci Rep

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“…Similarly, Bernhard et al [24] reported that 60% of their patients experienced injection site pain that lasted for 3 days. However, the pain of an intradermal Botox injection remains a problem, and multiple recent trials have tried to provide solutions using modified injection techniques [26,28] or manipulations of the pH of the solution, [29] which is the main cause of pain initiation.…”

Section: Discussionmentioning

confidence: 99%

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

Alhetheli

2021

Cosmetics

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Hyperhidrosis, or excessive sweating, negatively impacts patients both physically and psychologically. It may be primary or secondary: the primary form is a benign condition, with its growing prevalence reaching 5% recently. Its medical treatments are transitory. Objectives: Comparison of the outcomes of patients with primary palmar hyperhidrosis (PPH) after intradermal Botox injection (IBI) versus endoscopic thoracic sympathectomy (ETS). Methods: Forty patients were randomly divided into two equal groups. Patients in the IBI group received an intradermal injection of a botulinum toxin A. Patients in the EST group received endoscopic electrocautery of the sympathetic chain. The patients were evaluated biweekly for 12 weeks, and patient satisfaction by outcome was evaluated using a 4-point satisfaction score. Results: At 12 weeks, 60% of the IBI group patients had maintained an improvement. Meanwhile, 40% of the patients were improved compared to pre-intervention scores, despite deterioration after remarkable improvement. On the other hand, 80% of ETS group patients maintained their Hyperhidrosis Disease Severity Scale (HDSS) up until the end of follow-up. Patient satisfaction scores were significantly higher for the IBI group compared to the ETS group. Conclusions: Intradermal Botox injection is a simple, safe, non-invasive, and effective therapeutic modality for PPH and achieved higher patient satisfaction compared to ETS.

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“…The proper positioning of the needle is a substantial obstacle to ID delivery. Moreover, SC/ID injections may cause more pain than IM injections 129 . Due to the possibility of local irritation, induration, skin discoloration, inflammation, and granuloma formation following SC and ID delivery, the CDC advises that inactivated vaccines containing an adjuvant be injected into a muscle 119 , 130 .…”

Section: Consideration Of Injection Route or Targetmentioning

confidence: 99%

Immunogenicity of lipid nanoparticles and its impact on the efficacy of mRNA vaccines and therapeutics

Lee,

Jeong,

Park

et al. 2023

Exp Mol Med

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Several studies have utilized a lipid nanoparticle delivery system to enhance the effectiveness of mRNA therapeutics and vaccines. However, these nanoparticles are recognized as foreign materials by the body and stimulate innate immunity, which in turn impacts adaptive immunity. Therefore, it is crucial to understand the specific type of innate immune response triggered by lipid nanoparticles. This article provides an overview of the immunological response in the body, explores how lipid nanoparticles activate the innate immune system, and examines the adverse effects and immunogenicity-related development pathways associated with these nanoparticles. Finally, we highlight and explore strategies for regulating the immunogenicity of lipid nanoparticles.

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A Novel Technique to Reduce Pain from Intradermal Injection of Botulinum Toxin Type A

Cited by 9 publications

References 3 publications

Effects of lidocaine incorporation (without epinephrine) on pain and 2-week complications of botulinum toxin: a double-blind randomized placebo-controlled clinical trial

Effects of lidocaine incorporation (without epinephrine) on pain and 2-week complications of botulinum toxin: a double-blind randomized placebo-controlled clinical trial

Outcome Using Either Intradermal Botox Injection or Endoscopic Thoracic Sympathectomy for Patients with Primary Palmar Hyperhidrosis: A Comparative Study

Immunogenicity of lipid nanoparticles and its impact on the efficacy of mRNA vaccines and therapeutics

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