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Preoperative botulinum neurotoxin A for children with bilateral cerebral palsy undergoing major hip surgery: a

Elspeth Will1, Nicholas Magill2, Rebecca Arnold1

  • 1Evelina London Children's Hospital, London, UK.

Developmental Medicine and Child Neurology
|January 16, 2019
PubMed

Insights

Preoperative botulinum neurotoxin A (BoNT-A) injections did not reduce postoperative pain in children with cerebral palsy (CP) undergoing hip surgery. This study found no significant difference in pain levels between BoNT-A and placebo groups.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Neurology
  • Pain Management

Background:

  • Children with cerebral palsy (CP) often experience significant pain after major hip surgery.
  • Botulinum neurotoxin A (BoNT-A) is a potential therapeutic agent for muscle spasticity and pain management.

Purpose of the Study:

  • To evaluate the efficacy of preoperative botulinum neurotoxin A (BoNT-A) in alleviating postoperative pain in children with CP undergoing major hip surgery.
  • To assess the impact of BoNT-A on pain profiles and quality of life post-surgery.

Main Methods:

  • A randomized, parallel-arm, placebo-controlled trial was conducted with children aged 2-15 years with hypertonic CP.
  • Participants received either BoNT-A or placebo injections into hip muscles immediately before surgery.
  • The primary outcome, the pediatric pain profile (PPP), was assessed weekly for 6 weeks. Blinding was maintained for participants, clinicians, and assessors.

Main Results:

  • No significant difference in the mean (SD) pediatric pain profile (PPP) at 6 weeks was observed between the BoNT-A group (10.96 [7.22]) and the placebo group (10.04 [8.54]), with a p-value of 0.69.
  • Serious adverse events were reported in both groups during the 6-month follow-up period.
  • BoNT-A did not demonstrate a reduction in postoperative pain or an improvement in quality of life.

Conclusions:

  • Preoperative administration of botulinum neurotoxin A (BoNT-A) is not effective in reducing postoperative pain for children with cerebral palsy undergoing major hip surgery.
  • The findings do not support the use of BoNT-A for pain management in this specific surgical context.
Abstract

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