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Article

Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization

1
Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
2
Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON K7K 1Z6, Canada
3
Faculty of Medicine, Paris Cité University, 75006 Paris, France
4
Department of Physical Medicine and Rehabilitation, GH St Louis Lariboisière F. Widal, 75010 Paris, France
5
Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, ON L2T 4C2, Canada
6
PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86000 Poitiers, France
7
Department of Physical Medicine and Rehabilitation, Poitiers University Hospital, 86000 Poitiers, France
*
Authors to whom correspondence should be addressed.
Toxins 2024, 16(7), 304; https://doi.org/10.3390/toxins16070304
Submission received: 24 April 2024 / Revised: 25 May 2024 / Accepted: 26 June 2024 / Published: 2 July 2024
(This article belongs to the Special Issue Uses of Botulinum Toxin Injection in Medicine)

Abstract

Ultrasound guidance can enhance existing landmark-based injection methods, even through a brief and single exposure during a cadaveric training course. A total of twelve participants were enrolled in this training program, comprising nine physical medicine and rehabilitation specialists, one pediatrician, and two physician assistants. For each participant, one upper-limb muscle and one lower-limb muscle were randomly chosen from the preselected muscle group. Subsequently, participants were tasked with injecting both of their chosen cadaveric muscles with 1 mL of acrylic paint using a manual needle palpation technique, relying solely on their knowledge of anatomic landmarks. Participants then underwent a personalized, one-to-one ultrasound teaching session, lasting approximately five minutes, conducted by two highly experienced instructors. Following this instructive phase, participants were tasked with a second round of injections, targeting the same two muscles in the lower and upper limbs. However, this time, the injections were performed using anatomical landmarks and ultrasound guidance. To facilitate differentiation from the initial injections, a distinct color of acrylic paint was employed. When employing the anatomical landmark-based approach, the overall success rate for injections was 67%, with 16 out of 24 targeted muscles accurately injected. With the incorporation of ultrasound guidance, the success rate was 92%, precisely targeting 22 out of the 24 muscles under examination. There was an improvement in injection accuracy achievable through the integration of ultrasound guidance, even with minimal training exposure. Our single cadaveric ultra-sound training program contributes valuable insights to the utilization of ultrasound for anatomy training to help optimize the targeting of BoNT-A.
Keywords: ultrasound-guided; chemodenervation; botulinum toxin; muscle spasticity ultrasound-guided; chemodenervation; botulinum toxin; muscle spasticity

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MDPI and ACS Style

Heslot, C.; Khan, O.; Schnitzler, A.; Haldane, C.; David, R.; Reebye, R. Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization. Toxins 2024, 16, 304. https://doi.org/10.3390/toxins16070304

AMA Style

Heslot C, Khan O, Schnitzler A, Haldane C, David R, Reebye R. Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization. Toxins. 2024; 16(7):304. https://doi.org/10.3390/toxins16070304

Chicago/Turabian Style

Heslot, Camille, Omar Khan, Alexis Schnitzler, Chloe Haldane, Romain David, and Rajiv Reebye. 2024. "Enhancing Botulinum Toxin Injection Precision: The Efficacy of a Single Cadaveric Ultrasound Training Intervention for Improved Anatomical Localization" Toxins 16, no. 7: 304. https://doi.org/10.3390/toxins16070304

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