Perioperative Botulinum Toxin Injections to Enhance Surgical Outcomes in Patients With Spasticity: Preoperative, Intraoperative, and Postoperative Case Reports

Abstract

Spasticity causes an array of disabilities, which in turn may lead to the need for surgical intervention. Spasticity itself may also negatively affect surgical outcomes. This report reviews the potential benefit of perioperative (before, during, or after surgery) botulinum toxin (BoNT) injections for 3 patients with spasticity due to spinal cord injury, stroke, or multiple sclerosis. We discuss perioperative BoNT in 3 time periods: preoperatively, intraoperatively, and postoperatively. The cases demonstrate the use of perioperative BoNT in decreasing pain, improving wound healing, and improving surgical outcomes. We conclude by discussing the potential use of perioperative BoNT for surgical interventions in patients with spasticity and the need for further high-quality research in this field.

Canadian Physicians' Use of Perioperative Botulinum Toxin Injections to Spastic Limbs: A Cross-sectional National Survey

“…Spasticity may predispose patients to increased surgical complications in the perioperative period, which includes the pre-, intra- and postoperative stages. 11 Surgery itself may act as a noxious stimulus that increases spasticity in the intra- and postoperative periods, which could adversely affect tissue repair, joint anatomy, and wound healing processes resulting in poor surgical outcomes and surgical failure. 11 , 12 , 13 Optimizing spasticity management before surgery may therefore help decrease surgical complications.…”

“… 11 , 12 , 13 Optimizing spasticity management before surgery may therefore help decrease surgical complications. 11 , 12 , 13 …”

“…Perioperative BoNT injection has also led to a reduction of pain and spasticity and a decrease in analgesic use in patients undergoing surgery on their spastic limbs. 17 , 18 , 19 , 20 , 21 Perioperative BoNT injections can also optimize surgical outcomes of patients with spasticity undergoing orthopedic procedures not directly related to their preexisting spasticity, 11 , 17 , 18 , 19 , 20 , 21 , 22 Perioperative BoNT could therefore help improve surgical outcomes, alleviate postoperative pain, and facilitate rehabilitation participation. 11 …”

“…This case series highlighted that the use of perioperative BoNT may be effective in improving surgical outcomes in the 3 perioperative periods for patients undergoing unrelated surgery to their spasticity such as hip arthroplasty in a spastic limb, spasticity-related surgery such as tendon lengthening, and wound healing post wound-flap surgery from spasticity related pressure ulcers. 11 …”

“…There has been an increase in publications over the past 2 years regarding the use of perioperative BoNT to enhance outcomes of surgeries on spastic limbs, 10 , 11 , 13 , 17 , 21 , 23 but to date, there have not been any cross-sectional surveys to assess how frequently perioperative BoNT treatment is performed by physicians involved in spasticity management or physicians’ practice patterns regarding the timing of perioperative BoNT. Given the paucity of literature and absence of guidelines regarding perioperative BoNT injection to enhance outcomes of surgeries on spastic limbs, we organized a cross-sectional study to assess whether physicians are performing perioperative BoNT, with an ultimate goal to plan for the future development of Canadian guidelines.…”