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Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin

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Abstract

Introduction

Hyperhidrosis, causing excessive sweat, can be treated with Botulinum neurotoxin injection. Botulinum toxin, an effective and safe treatment for hyperhidrosis, unfortunately involves significant pain due to multiple injections. This study aims to propose a more efficient and less painful approach to nerve blocks for relief, by identifying optimal injection points to block the median nerve, thereby enhancing palmar hyperhidrosis treatment.

Methods

This study, involving 52 Korean cadaver arms (mean age 73.5 years), measured the location of the median nerve relative to the transverse line at the pisiform level to establish better nerve block injection sites.

Results

In between the extensor carpi radialis and palmaris longus, the median nerve was located at an average distance of 47.39 ± 6.43 mm and 29.39 ± 6.43 mm from the transverse line at the pisiform level.

Discussion

To minimize discomfort preceding the botulinum neurotoxin injection, we recommend the optimal injection site for local anesthesia to be located 4 cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles.

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Data are available on request.

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Acknowledgments

This study was conducted in compliance with the principles of the Declaration of Helsinki. Consent was obtaine donated their bodies to science for anatomical research. The results of such research can potentially increase the greatest gratitude. The authors thank Eun-Byul Yi from the Eonbuk Elementary School for the illustrations.

Funding

This work has been supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2022R1I1A1A01069499).

Author information

Authors and Affiliations

  1. Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, 50-1 Yonsei-Ro, Seoul, 03722, Republic of Korea

    Kyu-Ho Yi, Hyewon Hu & Hee-Jin Kim

  2. Department of Anatomy and Acupoint, College of Korean Medicine, Gachon University, 1332, Seongnam-daero, Sujeong-gu, Seongnam-si, 13120, Republic of Korea

    Ji-Hyun Lee

  3. Maylin Clinic (Ilsan), Goyangsi, Korea

    Jin-Hyun Kim

  4. Maylin Clinic (Apgujeong), Seoul, 06005, Korea

    Kyu-Ho Yi & Hyun-Jun Park

  5. Aeon Clinic, Singapore, Singapore

    Ki-Beom Kim

  6. Misogain Dermatology Clinic, Gimpo, Republic of Korea

    Ji-Hyo Kim

Authors
  1. Kyu-Ho Yi
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Contributions

All authors have reviewed and approved the article for submission. Conceptualization, K-HY, H-JP. Writing—original draft preparation, K-HY, J-HK. Writing—review and editing, J-HL. Visualization, H-WH. Supervision, H-JK.

Corresponding author

Correspondence to Hee-Jin Kim.

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The authors declare no competing interests.

Ethical approval

This study was conducted in accordance with the Declaration of Helsinki.

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Yi, KH., Lee, JH., Hu, H. et al. Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin. Surg Radiol Anat 45, 1083–1087 (2023). https://doi.org/10.1007/s00276-023-03199-4

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  • DOI: https://doi.org/10.1007/s00276-023-03199-4

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