Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Neuromuscular Blockade”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 307 records · Page 17Linked to original sources
PubMed1996

Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin.

PURPOSE: Because the aminoglycoside antibiotics and nondepolarizing muscle relaxants have interactions that vary, it is necessary to update the potential for such interactions when new drugs are introduced clinically. Rocuronium is a newly released steroidal nondepolarizing muscle relaxant with an intermediate duration of action. The following report is the first description of prolonged neuromuscular blockage after rocuronium in a patient who had received oral neomycin in anticipation of open bowel resection. CLINICAL FEATURES: A 71-yr-old woman with a two week history of bleeding pr was scheduled for exploratory laparotomy and right hemicolectomy. She received two standard bowel preparations consisting of oral erythromycin and neomycin over a two day period. Rocuronium was used to facilitate tracheal intubation and maintain muscle relaxation during a two hour operation. Despite clinical appearance of reversal of neuromuscular blockade after neostigmine and glycopyrolate, the patient complained of dyspnoea and weakness upon tracheal extubation and required reintubation twice. The reason for prolonged muscle relaxation was thought to be secondary to a rocuronium and neomycin interaction. CONCLUSION: Rocuronium, a new nondepolarizing muscle relaxant, has potential interactions with other drugs including the aminoglycoside antibiotics. This clinical report describes the failure of neuromuscular blockade reversal in a patient who received oral neomycin in anticipation of open bowel resection.

Administration, Oral↗
PubMed2004

Phonomyographic measurements of neuromuscular blockade are similar to mechanomyography for hand muscles.

PURPOSE: Phonomyography consists of recording low frequency sounds created during muscle contraction. In this study, phonomyography of three regions of the hand was compared to mechanomyography of the adductor pollicis. METHODS: In 12 patients, phonomyography was recorded via small condenser microphones taped over the thenar mass, the hypothenar eminence, and the dorsal groove between the first and second metacarpal bones to record the acoustic signals of adductor pollicis and the hypothenar and first dorsal interosseus muscles, respectively. Mechanomyography of the adductor pollicis was recorded simultaneously using a force transducer. After induction of anesthesia, the ulnar nerve was stimulated supramaximally using train-of-four (TOF) stimulation every 12 sec. Onset, maximum effect, and offset of neuromuscular block after rocuronium 0.6 mg x kg(-1) were measured using phonomyography and compared to mechanomyography using ANOVA and the Bland-Altman test. RESULTS: Phonomyographic measurements of onset and maximum effect of neuromuscular blockade were not significantly different from mechanomyographic measurements. Phonomyographic measurements of offset (T25%, T75 %, TOF 0.8) of neuromuscular block at the thenar muscles and first dorsal interosseus muscles were not significantly different from mechanomyographic measurements at adductor pollicis; however, T50%, T75% and T90% phonomyographic measurements at the hypothenar muscle were significantly shorter than at any other muscle site. CONCLUSION: There was good agreement between mechanomyographic measurements at the adductor pollicis muscle and phonomyographic measurements at the thenar and the first dorsal interosseus muscles. Phonomyography of those two muscles could be used interchangeably with mechanomyography of adductor pollicis for clinical purposes.

Analysis of Variance↗
PubMed2002

Screening patients with prolonged neuromuscular blockade after succinylcholine and mivacurium.

UNLABELLED: Patients with pseudocholinesterase (BChE) variants may exhibit markedly prolonged paralysis after the administration of succinylcholine or mivacurium. We sought to evaluate to what extent molecular biology may contribute to the biological assessment of such patients. We conducted a prospective cohort study in patients referred to our center between 1995 and 1999 for prolonged neuromuscular blockade after mivacurium or succinylcholine. For each patient, phenotyping was performed with a conventional biochemical technique and molecular biology for the detection of the atypical mutation (A variant). Among the 36 patients referred, 31 had low BChE activity, 26 had received mivacurium (BChE activity, 2.1 U/mL; 0.3-4.3 U/mL), and 5 had received succinylcholine (BChE activity, 1.9 U/mL; 1.1-3.2 U/mL) (mean; extreme values). The mean clinical duration of paralysis was 90 min (40-140 min) after succinylcholine and 301 min (120-720 min) after mivacurium. Thirty-two patients had a BChE deficiency of genetic origin: 20 were homozygous (AA), 10 were heterozygous (UA) for the A variant, and 2 did not have the A mutation (UU). One heterozygous UA patient had normal BChE activity. Nine among the heterozygous UA and the two homozygous UU patients probably carried a not-screened variant. In most cases, biochemical diagnosis was sufficient to confirm the existence of constitutional deficiency; molecular biology improved the accuracy of diagnosis in 11 patients (30%) but had few or no clinical implications for the patient him- or herself. IMPLICATIONS: Systematic screening for the pseudocholinesterase atypical variant by biochemical and DNA analysis after a prolonged neuromuscular blocking effect of succinylcholine or mivacurium shows that molecular biology could improve the diagnosis in approximately one third of patients, but with few clinical implications, compared with biochemical testing.

Adolescent↗
PubMed1997

[Prolonged neuromuscular blockade with vecuronium in patient with triple pregnancy treated with magnesium sulfate].

A 33 year-old parturient with triplet pregnancy underwent emergency cesarean section at 35 week of gestation under general anesthesia. The patient had received magnesium sulfate to prevent uterine contraction immediately before the cesarean section. Although serum magnesium value was not beyond therapeutic levels (3.3 mEq.l-1), the neuromuscular blocking effects with vecronium were strengthened. It was not likely that volatile anesthetic enhanced neuromuscular blockade produced by vecuronium because the onset time of vecuronium had already been faster than that in pregnant patients untreated with magnesium before she was exposed to isoflurane. In addition, it is possible that magnesium could interfere with postpartum uterine contractions because of its tocolytic properties. Magnesium sulfate therapy has several implications to anesthetic agents. We, anesthesiologists, should know about the biophysiological effects of magnesium and control the interaction between anesthetic agents and this electrolyte.

Adult↗
PubMed1988

Train-of-four fade during neuromuscular blockade induced by tubocurarine, succinylcholine or alpha-bungarotoxin in the rat isolated hemidiaphragm.

1. Nerve-evoked maximal twitches (T1, T2, T3, T4) of the rat isolated hemidiaphragm to train-of-four (TOF) stimulation (2 Hz X 2 s) were recorded continuously in the absence or presence of tubocurarine (1.5 mumol/l), succinylcholine (40 mumol/l) or alpha-bungarotoxin (1 mumol/l). The T1 and T4 response-time profiles for the three drugs were analysed with respect to amplitude depression and the TOF ratio (T4/T1) during the development of and recovery from neuromuscular blockade. 2. Tubocurarine produced T1 block accompanied by intense TOF fade; for the same degree of T1 block, the TOF ratio was lower during the recovery from blockade after washing out tubocurarine from the bath than during the onset of blockade. There was also a correspondingly slower recovery of the TOF ratio from 90% T1 block to control levels when compared with the time for complete T1 recovery. Fade and twitch tension depression were shown clearly to be separate responses, each with its own response-time profile. Fade is therefore not simply a consequence of postjunctional cholinoceptor blockade. 3. Succinylcholine produced T1 block with only moderate TOF fade; similar recovery rates from 90% T1 block to control levels were obtained for T1 and the TOF ratio. 4. alpha-Bungarotoxin produced irreversible and complete neuromuscular blockade during which TOF fade was virtually absent. 5. The results obtained in this study closely resemble those from other similar studies in animals and in humans and clearly demonstrate that the rat isolated hemidiaphragm is a suitable in vitro model for time course studies on TOF fade.

Animals↗
PubMed1997

[Intubation conditions and the development of neuromuscular blockade with rocuronium in endoscopic ORL surgery].

UNLABELLED: Rocuronium is a new nondepolarizing muscle relaxant for which a fast onset has been described. The goal of this study was to examine whether the characteristics of rocuronium could make it an appropriate relaxant for the anaesthetic management of operations of intermediate duration such as endoscopic upper airway surgery. These operations, which require the anaesthesiologist and surgeon to "share" the patient's airway, require good muscle relaxation for endotracheal intubation and placement of endoscopic instruments. In addition, the time course of neuromuscular blockade and its relation to the quality of intubating conditions were analysed. METHODS: The study was approved by the local ethics committee; 30 patients (ASA status 1-3) scheduled for elective endoscopic upper airway surgery were included after written informed consent. Exclusion criteria were suspected difficult intubating conditions, neuromuscular disease, or antibiotic therapy with aminoglycosides during the last 24 h. Anaesthesia was induced by propofol 2 mg/kg and alfentanil 1 mg after volume loading with 500 ml Ringer's lactate and preoxygenation, and was maintained by propofol infusion 5-8 mg/kg/h and repetitive alfentanil injections according to clinical needs. Endotracheal intubation was performed by a senior anaesthesiologist 90 s after injection of rocuronium 0.6 mg/kg (2 x ED95). Intubating conditions were graded 1 to 4 (1 = excellent, 2 = good, 3 = sufficient, 4 = inadequate). Acceleromyography was used for neuromuscular monitoring by means of the TOF-guard (organon Teknika/Biometer). The adduction movement of the thumb was measured by an acceleration transducer while stimulating the ulnar nerve at the wrist via surface electrodes in a supramaximal train-of-four (TOF) mode (2 Hz every 15 s). Twitch height and TOF ratio were documented during the course of neuromuscular blockade. Data are presented as mean +/- standard deviation. RESULTS: Patients were aged 37 to 64 years (mean 54 +/- 7). Intubating conditions were excellent in 17 cases and good in 7. In 2 cases intubating conditions were graded sufficient, as patients could be easily intubated but showed clear diaphragmatic movements at intubation. In 4 patients intubating conditions could not be judged, as a laryngoscopic view of the glottic structures was impossible for anatomic reasons. Neuromuscular block at intubation was 78 +/- 22%, onset time 152 +/- 62 s, clinical duration 30 +/- 8 min, and recovery index 11 +/- 4 min. The TOF ratio required 51 +/- 14 min to return to 0.7. CONCLUSIONS: Good to excellent intubating conditions can be expected 90 s after injection of rocuronium 0.6 mg/kg. Diaphragmatic reactions cannot be excluded. Complete relaxation of the adductor pollicis muscle is not necessary for endotracheal intubation. Intubation at a certain time interval, for example, 90 s after injection of rocuronium 0.6 mg/kg, can be recommended. Onset and recovery characteristics of rocuronium make it an appropriate relaxant for the anaesthetic management of operations of intermediate duration such as endoscopic upper airway surgery. Care should be given, however, to detect inadequate recovery of neuromuscular transmission, as there are considerable interindividual differences in recovery.

Adult↗
PubMed1986

Assessment of the Datex Relaxograph during anaesthesia and atracurium-induced neuromuscular blockade.

The Datex Relaxograph is a recently introduced electromyographic monitor of neuromuscular transmission. It has been assessed in patients requiring neuromuscular blockade and the results compared with those obtained simultaneously with a force transducer. There was a good correlation between the two methods of measurement for both twitch height and train-of-four ratio (correlation coefficients 0.93 and 0.97, respectively). The Datex Relaxograph proved easy to use in the clinical setting.

Anesthesia, General↗
PubMed1991

[The effect of succinylcholine on the recovery of atracurium-induced neuromuscular blockade].

At the end of abdominal surgery, a brief but profound neuromuscular blockade may be needed to facilitate closure of abdominal wall. Succinylcholine (Sch) was the agent used in this regard before. This study was undertaken to observe the effect after administration of Sch (1 mg/kg) at various levels of recovery from atracurium. 40 ASA I or II patients undergoing elective surgery were randomly assigned to one of four groups with 10 in each. Anesthesia was induced with thiopental 5 mg/kg and Sch 1.5 mg/kg i.v., and maintained with 0.7% isoflurane (end-tidal concentration) and 50% N2O in O2 The electromyographic response of the hypothenar muscle was recorded in response to supramaximal train-of-four stimuli delivered to the ulnar nerve at 20 s intervals using a relaxograph (Datex). Control records were obtained after induction of anesthesia. When the first twitch (T1) had recovered above 50% from the intubating dose of Sch, atracurium 0.5 mg/kg was administered. Spontaneous recovery of T1 was observed. Patients in group I received 1 mg/kg of Sch, when T1 returned to 20% and those in groups II, III, and IV received the same dose of Sch when T1 returned to 40%, 60% or 80% of control respectively. The response was observed at 20s intervals for at least 5 min after the administration of Sch. It was regarded as effective response if the T1 returned to less than 5% of control.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Monitoring neuromuscular blockade in the intensive care unit: the peripheral nerve stimulator.

Traditionally, neuromuscular blocking agents (NMBAs) have been administered in the operating room as an adjunct to anesthetics. Recent studies in the United States have indicated that 98% of the anesthesiologists and critical care nurses surveyed use NMBAs at least occasionally. When monitoring the use of NMBAs, a combination of clinical monitoring and peripheral nerve stimulator monitoring has been recommended. However, the most effective techniques have yet to be described. Understanding the complexities of NMBAs and the absolute need for accurate monitoring techniques is imperative for clinicians. The purpose of this literature review is to evaluate current literature regarding monitoring techniques of NMBAs and to guide the advanced practice nurse's role in critical care.

Anesthesia↗
PubMed1979

Effects of neuromuscular blockade on respiratory mechanics in conscious man.

The effect of submaximal neuromuscular blockade (SMNB) on lung and chest wall mechanics was studied in six normal, awake subjects infused with pancuronium. Measurements of static lung volumes, specific airway conductance (sGaw), maximum expiratory and inspiratory flow-volume (MEFV, MIFV) curves, and static pressure-volume (PV) curves of the lung and of the relaxed chest wall were obtained after lung recoil pressure (Pst(L)) at full inflation had been reduced to 60 +/- 10% of control. Inspiratory capacity was decreased, but residual volume was not increased. Inspiratory PV curve of the lung was not modified, and the observed decrease in expiratory compliance and the slight increase in Pst(L) during deflation were compatible with the altered lung volume history. SMNB did not modify sGaw nor the relationship between Pst(L) and MEF; by contrast it markedly reduced MIF rates. Finally, SMNB transposed the chest wall PV curve to higher levels on the pressure axis (it decreased the outward pull of the chest wall) without greatly affecting its slope, and thereby it reduced the resting level of the respiratory system. We conclude that 1) muscle weakness per se does not affect the eleastic properties of the lungs and airways, and 2) involuntary respiratory muscle activity influences the elastic recoil of the chest wall. We believe this muscle activity originates from muscle spindles, and lies essentially in the inspiratory portion of the intercostal musculature.

Adult↗
PubMedDate not supplied

Prolonged neuromuscular blockade associated with trimethaphan: a case report.

A case of prolonged neuromuscular blockade associated with the administration of trimethaphan to a neurosurgical patient aged 29 is believed to be the possible result of interaction between trimethaphan, a ganglionic-blocking drug, and muscle relaxant. This possibility should be kept in mind when the administration of trimethaphan is being considered.

Adult↗
PubMed1998

Onset and recovery of neuromuscular blockade after two doses of rocuronium in children.

STUDY OBJECTIVE: To determine if 450 micrograms/kg (1.5 times the ED95) of rocuronium would result in a comparable onset with a shorter duration of action when compared with 600 micrograms/kg (2 times the ED95). DESIGN: Randomized, single-blind study. SETTING: Teaching hospital. PATIENTS: 85 ASA physical status I and II children ages 2 through 12, undergoing elective surgery with an inhalation induction using halothane. INTERVENTIONS: Group 1 received 600 micrograms/kg rocuronium, and Group 2 received 450 micrograms/kg rocuronium. MEASUREMENTS AND MAIN RESULTS: The two groups were compared using a Student's t-test, with p < 0.05 significant. The time of onset, or time to 95% suppression of neuromuscular twitch with standard errors, was 140 +/- 13 seconds (range 46 to 365 sec) in Group 1 and 148 +/- 13 seconds (range 82 to 345 sec) in Group 2 (NS = not significant). The times to 25% return of twitch from baseline (T25) in Groups 1 and 2 were 28 +/- 1.5 minutes (range 14 to 45 min) and 26 +/- 1.6 minutes (range 10 to 55 min), respectively (NS). The differences between these two doses in onset of, and recovery from, block were not found to be statistically significant. The results, however, excluded 5% of the higher dose group and 31% of the lower dose group who did not achieve 95% suppression of twitch. Time to maximal suppression of neuromuscular blockade, however, was not statistically significant for the 85 patients with a time of 270 +/- 28 seconds (range 91 to 605 sec) with a mean maximal suppression of 98.7% in Group 1 and 313 +/- 25 seconds (range 91 to 899 sec) with a mean maximal suppression of 93.1% in Group 2. CONCLUSION: The two doses of rocuronium did not differ statistically in onset or duration. Rocuronium at 600 micrograms/kg offers more reliability than 450 micrograms/kg in achieving adequate muscle relaxation, and the lower dose may result in a significantly large number of patients who may have inadequate intubating conditions.

Androstanols↗
PubMed1999

Electrophysiological and ultrastructural analysis of the neuromuscular blockade and miotoxicity induced by the Micrurus nigrocinctus snake venom.

Micrurus nigrocinctus is the most abundant coral snake in Central America. The venom of this specie induced a concentration-dependent (10-20 micrograms/ml) depolarization in the isolated mouse phrenic nerve-diaphragm preparations incubated at 37 degrees C. d-Tubocurarine (10 micrograms/ml) and (alpha beta ungarotoxin (3-5 micrograms/ml) were able to partially protect against the depolarization induced by the venom (10 micrograms/ml), suggesting the involvement of subsynaptic cholinergic receptors. This venom (10 micrograms/ml) also increased the frequency and amplitude of miniature end-plate potentials (mepps) during the first 10-20 min of incubation. Subsequently, the mepps progressively decreased and disappeared after 60 min. These responses were accompanied by ultrastructural changes involving the nerve terminals, the subsynaptic junctional folds and the muscle mitochondria. The synaptic gutter was shallow and, very often, "shrunken" terminals with omega-shaped axolemmal indentations and a decreased number of synaptic vesicles were present. A common finding was the presence of numerous finger-like, membrane-bounded bodies interposed between the terminal and the Schwann cells or postsynaptic sarcolemma. The preincubation of the venom with specific antivenom or the incubation of the preparations at room temperature (24-26 degrees C) reduced the number and intensity of the ultrastructural alterations. The last finding suggests the involvement of a enzymatic process, probably a phospholipase A2, present in the venom. There was a good correlation between the electrophysiological and ultrastructural effects induced by the venom which allow us to conclude that M. nigrocinctus venom has a presynaptic action in the initial stages of intoxication followed by sub- and postsynaptic effects, the last being the most important cause of neuromuscular blockade. A direct action of the venom on muscle fibers may also contributes to the irreversible blockade.

Animals↗
PubMed1980

Potentiation of neuromuscular blockade in man produced by combinations of pancuronium and metocurine or pancuronium and d-tubocurarine.

Simultaneous administration of combinations of pancuronium, metocurine, and d-tubocurarine (dTc) were given to A.S.A. class I-II surgical patients during N2O-narcotic-thiopental anesthesia to determine the degree of neuromuscular blockade produced. The pancuronium-metocurine and the pancuronium-dTc combinations were each significantly more potent (p < 0.05) than the additive effects of each of the individual drugs given alone. This greater than additive neuromuscular blocking effect was not seen with the metocurine-dTc combination. Despite the potentiation of neuromuscular blocking intensity by the pancuronium-metocurine and the pancuronium-dTc combination, the duration of blockade was not prolonged. Possibly, such potentiation of neuromuscular blockade might be attributed to simultaneous pre- and postjunctional receptor inhibition. Additional mechanisms might involve augmented conformational attachment to pre- and postjunctional cholinergic receptors or altered protein binding such that a greater than expected proportion of unbound drug reaches its neuromuscular site of activity. Regardless of mechanism, combining pancuronium with dTc or with metocurine can provide surgical relaxation or ideal conditions for endotracheal intubation with smaller amounts of each drug than would be anticipated if their effects were simply additive.

Dose-Response Relationship, Drug↗
PubMed1998

The response of patients with Duchenne's muscular dystrophy to neuromuscular blockade with vecuronium.

BACKGROUND: The authors hypothesized that patients with Duchenne's muscular dystrophy (DMD) are more sensitive to nondepolarizing muscle relaxants. METHODS: Eight children with DMD and eight healthy children having orthopedic procedures were studied. Anesthesia consisted of thiopental, 60% nitrous oxide in 40% oxygen, and intravenous fentanyl and midazolam. Using electromyography, the ulnar nerve was stimulated and the electromyographic train-of-four ratio (TOFr) of the first dorsal interosseous muscle was recorded every 60 s. After baseline TOFr recording, all patients received 50 microg/kg vecuronium and the TOFr at 3 min was compared. Vecuronium (10 microg/kg) was then administered every minute until TOFr was < or =0.1. The TOFr was followed until TOFr was > or =0.01. Then 10 microg/kg of vecuronium were administered to maintain TOFr < or = 0.1. At the conclusion of the procedure, TOFr was allowed to recover to 0.25, and then neostigmine and glycopyrrolate were administered. Data are presented as medians and ranges. RESULTS: The initial dose of vecuronium resulted in greater TOFr depression in patients with DMD than in controls (0.14 vs. 0.86). Less vecuronium was needed to produce TOFr < or = 0.1 in the patients with DMD than in the control patients (55 microg/kg vs. 95 microg/kg). Recovery time for the TOFr to > or =0.1 after the initial dose was longer in the patients with DMD than in the controls (28 vs. 20 min; P = 0.03), and the maintenance dose of vecuronium was less in patients with DMD (0.6 vs. 1.3 microg x kg[-1] min[-1]; P < 0.01). The time for TOFr recovery from 0.1 to 0.25 was 36 min in the patients with DMD and 6 min in the controls (P < 0.01). After neostigmine, the TOFr was 1.0 in the controls and 0.91 (P = 0.03) in the patients with DMD. CONCLUSION: There is increased sensitivity to vecuronium from neuromuscular blockade in patients with DMD.

Adolescent↗
PubMedDate not supplied

Autonomic and cardiovascular effects of neuromuscular blockade antagonism in the dog.

Autonomic and cardiovascular changes were studied when neuromuscular blockade was antagonized in 96 dogs with one of eight anticholinesterase-antimuscarinic drug combinations. Neostigmine (50 or 100 micrograms/kg) was administered before or after atropine (40 micrograms/kg) or glycopyrrolate (10 micrograms/kg). The high dose of neostigmine (100 micrograms/kg) caused bradyarrhythmias, salivation, and signs of bronchosecretion when used with either antimuscarinic agent and irrespective of the administration sequence. The heart rate increased, but not significantly, when atropine was injected before either dose of neostigmine. This did not occur when this administration sequence was reversed. Arrhythmias and cardiovascular and autonomic changes did not occur when glycopyrrolate was injected before or after neostigmine at 50 micrograms/kg.

Animals↗
PubMed1979

Prolongation of pancuronium-induced neuromuscular blockade by intravenous infusion of nitroglycerin.

Based upon clinical observation of undue prolongation of pancuronium-induced blockade in the presence of intravenous infusion of nitroglycerin, neuromuscular blockades produced by pancuronium, succinylcholine and d-tubocurarine were studied in 51 cats using the sciatic-gastrocnemius nerve-muscle preparation. Pancuronium-induced blockade was found to be significantly prolonged (P less than 0.1) in the presence of a nitroglycerin infusion of 1 microgram/kg/min (65 vs. 127 min). Less, but still significant, prolongation occurred when nitroglycerin, 0.5 microgram/kg/min, was infused. The intravenous infusion of nitroglycerin must be started prior to the pancuronium injection for the block to be prolonged. Neuromuscular blocks produced by succinylcholine and d-tubocurarine were not altered by nitroglycerin. In experiments using the isolated rat diaphragm preparation, the depth of pancuronium-induced block was found not to be changed by nitroglycerin, suggesting an effect of nitroglycerin on the process of recovery from blockade. These findings indicate a selective pancuronium-nitroglycerin interaction.

Animals↗
PubMed2002

Treatment of upper extremity spasticity in stroke patients by focal neuronal or neuromuscular blockade: a systematic review of the literature.

Studies published from January 1966 until October 2000 on the clinical effects of focal neuronal and neuromuscular blockade in post stroke upper limb spasticity were identified. Twelve studies were included and evaluated on 13 methodological criteria. Ten studies on Botulinum toxin type A (BTX-A) treatment were found (of which 4 were randomised controlled trials (RCTs) and 6 were uncontrolled observational studies) as well as one uncontrolled observational study on phenol blockade of the subscapular muscle and one on alcohol blockade of the musculocutaneus nerve. The homogeneity of the patient groups with regard to diagnosis and their comparability with regard to functional prognosis and other sources of bias were generally unsatisfactory. Only two RCTs met predetermined criteria of minimal validity. There is evidence of effectiveness of BTX-A treatment on reducing muscle tone (varying between 0.8 and 2.0 points on the modified Ashworth scale) and improving passive range of motion at all arm-hand levels in chronic stroke patients for approximately 3-4 months. There is also preliminary evidence of a synergistic effect of concomitant electrostimulation. Taking into account a critical maximum dose of 100 MU Botox" (300-500 MU Dysport) for preserving active finger flexion, BTX-A treatment seems to be a safe focal spasmolytic treatment. Effectiveness of BTX-A treatment on improving functional abilities could not be convincingly demonstrated, although two subgroups may be identified that might specifically benefit at a functional level: (1) patients with mild spasticity and a potential for voluntary extensor activity and (2) patients with severe spasticity suffering from problems with positioning and taking care of the affected arm and hand. Larger controlled studies are needed to compare the effectiveness of BTX-A with other focal spasmolytic techniques paying special attention to individual goal assessment, the (duration of) functional benefits, co-treatment and aftercare, side-effects and cost-effectiveness.

Botulinum Toxins↗