This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (44)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Pain  • Randomized Controlled Trial  • Facial Plastic Surgery  • Cosmetic Surgery/ Procedures  • Alert me on articles by topic  Social Bookmarking   What's this?

A Double-blind, Randomized Controlled Trial

Murad Alam, MD; Jeffrey S. Dover, MD, FRCPC; Kenneth A. Arndt, MD

Arch Dermatol. 2002;138:510-514.

Context  Botulinum A exotoxin is used for various indications, including the treatment of dynamic forehead lines.

Objective  To determine whether injection with botulinum A exotoxin reconstituted with preservative-containing normal saline (isotonic sodium chloride) is less painful than injection with exotoxin that has been reconstituted with preservative-free saline.

Design  Two arms: (1) retrospective study; (2) double-blind, randomized controlled trial.

Setting  A multiple-physician dermatology practice.

Patients  (1) Retrospective study—20 consecutive adult patients presenting for treatment of upper-face dynamic lines; (2) prospective study—15 consecutive adult patients presenting for treatment of upper-face dynamic lines.

Intervention  In prospective study only, one side (left or right) of the face was treated with exotoxin reconstituted with preservative-containing saline, and the other side, with exotoxin reconstituted with preservative-free saline.

Main Outcome Measures  (1) Retrospective study—discomfort at current treatment (with preservative-containing saline) compared with discomfort with most recent prior treatment (with preservative-free saline); (2) prospective study—discomfort on the side treated with preservative-containing saline compared with discomfort on the side treated with preservative-free saline.

Results  (1) Retrospective study—18 (90%) of 20 patients reported that treatment with exotoxin reconstituted with preserved saline was less painful than prior treatment with exotoxin reconstituted with preservative-free saline; (2) prospective study—15 (100%) of 15 patients reported less pain in the side of their face treated with exotoxin reconstituted with preservative-containing saline (P<.001). Pain on the preservative-containing side was 54% less. No difference in treatment efficacy between the sides was observed by investigators or patients.

Conclusion  Use of preservative-containing saline to reconstitute botulinum A exotoxin can significantly decrease patient discomfort on injection.

From SkinCare Physicians, Chestnut Hill (Drs Alam, Dover, and Arndt), and Harvard Medical School, Boston (Dr Arndt), Mass; and Dartmouth Medical School, Hanover, NH (Drs Dover and Arndt).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Intrafollicular Orifice Injection Technique for Botulinum Toxin Type A
Lewis et al.
Arch Dermatol 2008;144:1657-1658.
FULL TEXT  

Response
Felber
JAOA: Journal of the American Osteopathic Association 2007;107:173-174.
FULL TEXT  

Why Make Patients Exercise Facial Muscles for 4 Hours After Botulinum Toxin Treatment?
Hsu et al.
Arch Dermatol 2003;139:948-948.
FULL TEXT  

Botulinum A Exotoxin for Hyperfunctional Facial Lines: Where Not to Inject
Alam et al.
Arch Dermatol 2002;138:1180-1185.
FULL TEXT  

Saline with Preservative May Make Botulinum Toxin A Injections Less Painful
Journal Watch Dermatology 2002;2002:1-1.
FULL TEXT