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Related Concept Videos

Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin01:26

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Directly acting muscle relaxants like dantrolene and botulinum toxin (BoNT) have distinct mechanisms and applications. Dantrolene, a hydantoin derivative, acts on the ryanodine receptor (RYR1) in skeletal muscle cells. RYR1 are calcium channels present at the sarcoplasmic reticulum membrane. In response to excitation, they release calcium ions from the sarcoplasmic reticulum to the cytosol. Calcium promotes actin-myosin-mediated contraction of muscles.
The binding of dantrolene to the RYR1...
969

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Updated: Dec 7, 2025

Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
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Botulinum Toxin A in Tissue Expander Breast Reconstruction: A Double-blinded Randomized Controlled Trial.

Valerie Lemaine1, Christine M Lohse2, Jay N Mandrekar2

  • 1Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minn.

Plastic and Reconstructive Surgery. Global Open
|September 28, 2020
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Intraoperative botulinum toxin A (BTX-A) injections did not significantly reduce pain or improve physical well-being during subpectoral tissue expander breast reconstruction. This study found no benefit of BTX-A over placebo for pain management in these patients.

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Area of Science:

  • Plastic Surgery
  • Reconstructive Surgery
  • Pain Management

Background:

  • Subpectoral tissue expander breast reconstruction frequently causes muscle spasms, pain, and discomfort during the expansion process.
  • Botulinum toxin A (BTX-A) is a potential agent to alleviate muscle-related pain and discomfort.

Purpose of the Study:

  • To investigate the efficacy of intraoperative botulinum toxin A (BTX-A) injection in the pectoralis major muscle for reducing pain.
  • To assess the impact of BTX-A on patients' physical well-being during subpectoral tissue expander breast reconstruction.

Main Methods:

  • A randomized trial involving 131 women undergoing immediate subpectoral tissue expander breast reconstruction.
  • Participants received either 100 units of BTX-A or a placebo injection in the pectoralis major muscle.
  • Pain intensity and physical well-being (BREAST-Q) were measured throughout tissue expansion.

Main Results:

  • No statistically significant difference in the change of pain intensity scores between the BTX-A and placebo groups (P=0.55).
  • No significant difference in the change of physical well-being scores (BREAST-Q) between the groups (P=0.89).
  • Median pain intensity and BREAST-Q scores showed similar trends in both treatment arms.

Conclusions:

  • Intraoperative intramuscular injection of 100 units of BTX-A in the pectoralis major muscle did not reduce postoperative pain.
  • BTX-A did not improve patient-reported physical well-being compared to placebo in this cohort.
  • The findings suggest BTX-A is not effective for managing pain and discomfort in subpectoral tissue expander breast reconstruction.