What is included in preprocedural planning of botulinum toxin (BTX) injections for pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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After written informed consent, injection sites and dosing are preplanned so that the procedure is performed efficiently. Sometimes, a patient may blame BTX therapy for a preexisting cosmetic flaw; therefore, preinjection photographs are advisable. By avoiding needle contact with the periosteum, using small volumes of concentrated injectate (1-2 cc of preservative-free normal saline per 100 U) and using a 30-gauge, 0.5-inch needle coupled with deliberate rapid injection techniques, topical anesthesia is usually unnecessary.

In heavily muscled or obese patients, a longer needle, as long as 1.5 inches, may be required to reach symptomatic muscles in the cervical-thoracic paraspinal and trapezius regions. Some injectors advocate a higher dilution of BOTOX® 100 U into 2-4 cc of vehicle. [162]

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