Perioperative Botulinum Toxin Injections to Enhance Surgical Outcomes in Patients With Spasticity: Preoperative, Intraoperative, and Postoperative Case Reports.
Geoffrey Frost, Heather Finlayson, Sepehr Saeidiborojeni and 2 others
PMID 33778474WHAT IT FOUND
Favorable outcomes were reported after surgery, botulinum toxin, and postoperative care in three patients with spasticity, but without controls these reports cannot show the toxin caused the improvement.
Key findings
01A patient received botulinum toxin two weeks before total hip replacement and was able to participate in rehabilitation without delay.
02After a failed tendon transfer, a patient received botulinum toxin during surgery and wore the splint with mild dystonia and good tendon healing.
03A patient received botulinum toxin 12 days after flap surgery, and the wound and osteomyelitis resolved.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only three cases were reported, each with a different cause of spasticity and a different surgery, so this is a description of what happened, not a test of whether botulinum toxin helps. There was no control group, randomization, or blinding, and the authors state they cannot draw firm conclusions about efficacy. Each patient also had surgery and postoperative care, so the contribution of any single component, including botulinum toxin, cannot be separated. The timing of injection varied before, during, and after surgery, and the authors say optimal timing, dosage, and reinjection intervals are unknown. The reported outcomes were favorable, with no comparison group to show what would have happened without perioperative botulinum toxin.
Declared interests
No funding or conflict-of-interest statement is provided in the supplied text. The article lists Xeomin (Merz Pharmaceuticals), E-Stim (Natus), and Botox (Allergan) as suppliers.
The easy way to misread this
Do not conclude that perioperative botulinum toxin improves surgical outcomes. These three cases had surgery, botulinum toxin, and postoperative care together, had no control group, and the authors state they cannot draw firm conclusions about efficacy.