• Reggie C Hamdy, Kathleen Montpetit, Ellen M Raney, Michael D Aiona, Ramona R Fillman, William MacKenzie, James McCarthy, Ross S Chafetz, Susan Sienko Thomas, Cynthia M Tamayo, Aaron G Littleton, Joanne Ruck-Gibis, Susan N Takahashi, Mario Rinaldi, G Allen Finley, Robert W Platt, and Noémi Dahan-Oliel.
• Shriners Hospital for Children, Montreal, Quebec, Canada. rhamdy@shriners.mcgill.ca
• J Pediatr Orthop. 2009 Jul 1; 29 (5): 427-34.

BackgroundThe Ilizarov technique is commonly used for lengthening and deformity corrections of the lower limbs in children. Postoperative pain can be significant, affecting quality of life and functional mobility, and often requiring prolonged medication use. Several studies have investigated the antinociceptive actions of botulinum toxin type A (BtX-A), yet evidence for its use in this population is limited. The objectives were to (1) establish the feasibility of a randomized clinical trial in children undergoing limb lengthening or deformity correction and (2) provide preliminary evidence of the beneficial effects of BtX-A in this population.MethodsFifty-two patients with a mean age of 13.7 years (range, 5 to 21 y) were randomized to receive either BtX-A or an equivalent volume of sterile saline solution (placebo group), as a single dose during the surgical procedure. Pain, medication use, quality of life, and functional mobility outcomes were assessed in all patients. Adverse events were reported for all patients and classified as minor or major.ResultsDifferences between groups did not reach statistical significance; however, pain at mid-distraction was found to be slightly lower in the BtX-A group, as compared with the placebo group. Patients in the BtX-A group used less parenteral pain medication in the first 4 days after the surgery, had higher quality of life scores at 3 of the 5 time points assessed, and slightly higher functional mobility scores. All adverse events were expected complications of the lengthening process. No event was considered to be a serious adverse event related to the BtX-A injection itself. There was a trend toward fewer major adverse events in the BtX-A group.ConclusionsThis pilot study established the feasibility of a randomized controlled trial design for in this population. Its findings indicate that BtX-A injections appear to be safe and effective for reducing pain and improving the quality of life and functional mobility of children undergoing lengthening or deformity corrections of the lower limbs. A larger-scale study is currently underway to confirm these preliminary findings.

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