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ESRA19-0238 Treatment of primary palmar hyperhidrosis with multiple botox injections with and without prior ultrasound-guided nerve blocks – a local improvement project
  1. C Bernhoff1,
  2. ME Jepsen2,
  3. DS Hæstrup1,
  4. K Tanggaard1 and
  5. J Børglum1
  1. 1Zealand University Hospital, Roskilde, Anesthesiology and Intensive Care Medicine, Roskilde, Denmark
  2. 2CAMES, Copenhagen Academy of Medical Education and Simulation, Copenhagen, Denmark


Background and aims Primary palmar hyperhidrosis (PPH) is a medical condition characterized by excessive sweat secretion of the palms. PPH impacts the patients work and social life. At Zealand University Hospital, patients are offered multiple injections of botox (BTX) to reduce the excessive sweat secretion. BTX injections are associated with severe pain and the treatment needs repeating every 6 months. Previously, the pain treatment for this procedure was local infiltration. To improve the current pain treatment, patients are now offered peripheral nerve blocks before BTX injections.

Methods Prior to the BTX injections, the anaesthetist performed an ultrasound-guided (USG) median and ulnar nerve block with 4–6 ml lidocaine 0.1% at each site of injection. After 20 minutes, the dermatologist injected the BTX. After treatment, the patients were asked to fill out an anonymous questionnaire. The questionnaire had two parts: experience with BTX injections with and without prior nerve blocks.

Results Twelve patients filled out the questionnaire. 75% of patients had previously received BTX injections without prior nerve blocks and associated this with a pain score of 8 [4–9] (Median [Range], NRS 0–10). 92% of patients received BTX treatment that day with a prior median and ulnar nerve block and reported a pain score of 1.0 [1–8] (Median [Range], NRS 0–10). 92% of patients receiving BTX injections would prefer USG nerve blocks prior to the procedure.

Abstract ESRA19-0238 Figure 1

Conclusions Ultrasound-guided nerve blocks of the ulnar and median nerves seems to reduce pain associated with BTX injections. USG nerve blocks are now routinely offered before treatment with BTX at our institution.

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