Botox A injection for pain after laparoscopic ventral hernia: a case report

Abstract

Introduction: Laparoscopic ventral hernia repair has many advantages over open techniques: adequate visualization of the entire abdominal wall, ease of placement of preperitoneal mesh with adequate overlap, and cosmesis. Intense and activity limiting pain is often one inferior aspect of this repair. We report the case of a patient who was intolerant of narcotic pain medicine with activity limiting pain. A novel technique for postoperative pain control was instituted utilizing Botox A (Allergan Inc., Irvine, CA, USA).

Methods: Botox A was diluted to 2 units per mL and three injection sites were chosen on each side of the abdominal wall. All three muscle bellies (external oblique, internal oblique, and transversus) were identified by ultrasound and 8 mL was injected in each. This resulted in three muscle layers at six sites for a total of 18 injections. A total of 300 units of Botox A were utilized.

Results: Pain scores improved from 10/10 to 2/10 and were durable at 3-month follow up.

Conclusion: Botox A provided significant pain control for this patient after laparoscopic ventral hernia repair. Continued prospective study to define long-term outcomes, cost savings, and appropriate timing of injections is underway.