Botulinum Toxin Injection

WHAT IS A BOTULINUM TOXIN (BOTOX) INJECTION?

Botulinum Toxin Injection: is an injection performed in the specific muscles to treat painful conditions with skeletal muscle (like: spasticity, headache, neck pain, back pain, involuntary muscle contraction, myofascial pain). A fine needle is used to inject Botox directly into the muscles that are overactive or painful. The relief may be seen within three days after the injection and may last up from three to six months. At times, an electromyographic machine is used to ensure that Botox is placed directly into the muscle.

What is Botulinum Toxin Type A or BOTOX: is a purified protein, derived from bacteria given in therapeutic doses to treat overactive muscles activity.

BEFORE THE PROCEDURE

• Please arrive 30 minutes before your scheduled appointment.
• First, you will meet with a Patient Access Representative (PAR) at the registration desk that will review your medical insurance, Emirates ID and perform your clinic registration. (Please bring your medical insurance card and Emirates ID).
• You will then see a nurse who will obtain your medical history and perform a nursing physical assessment.
• You will then meet with the pain physician for an evaluation and who will also explain the procedure in detail, including possible complications and side effects. Your physician will obtain the consent for procedure and will answer any questions that you may have.

• Inform your pain physician: - If you have any muscle or nerve condition (ALS or Lou Gehrig’s disease), myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of BOTOX. - If you are nursing or may possibly be pregnant. - If you have allergic reaction to albumin. - If you have allergic reaction to any Botulinum Toxin product.
• Discontinue any pain medication four hours before the time of your scheduled procedure. Continue to take all other medications (when you are instructed) with a small sip of water before coming for the procedure. Bring all medications with you so that you can take it after your procedure (take only what is due after the procedure or as instructed by your primary or referring physician).
• Dizziness. Lying down usually helps relieve dizziness, since it is frequently caused by a decrease in your blood pressure. Gradually sit up and then stand after at least 10 minutes of sitting.
• Mild headache. Drink plenty of fluid and take pain medication, as directed. If the headache continues or becomes severe, contact your physician or go the nearest Emergency Room.
• Mild discomfort on injection site when the local anesthetic wears off. This usually lasts two or three hours. If it occurs, apply ice to the area the day of the procedure and moist heat the day after the procedure if the discomfort persists.

THE DAY OF THE PROCEDURE

• You will meet with the Patient Access Representative (PAR) who will review your Emirates ID, medical insurance and registration. (Please bring your insurance card and Emirates ID).
• You will then meet with a nurse who will review your medical history, medication and obtain your pre-procedure vital signs.
• You will then be taken to the procedure room and be assisted to get on the procedure table or a chair.

DURING THE PROCEDURE

• The procedure takes approximately 20 minutes, but may vary depending on the location of the muscles to be injected.
• The procedure area (forehead, neck, arm, hand, upper, middle or lower back) will be cleansed with an antiseptic solution.
• The physician will then give the injection to the indicated painful muscles using a fine needle.
• A nurse will monitor your vital signs during your procedure.
• A nurse will monitor your vital signs during your procedure.
• A plaster may be placed over the injection site, if necessary.

AFTER THE PROCEDURE

• You may be transferred to the recovery for observation, if necessary. Otherwise you can be discharged immediately after the injection.
• While in the recovery room, a nurse will check your vital signs.
• You may feel some soreness at the point where the needle enters the skin after the procedure.
• A nurse will give you a beverage and review your discharge instructions.
• A responsible adult must accompany you home.
• You will meet back with the Patient Access Representative (PAR) at the registration desk who will review your follow up appointment schedule.

DISCHARGE INSTRUCTIONS

• Do not rub the injected area for 12 hours.
• Do not lie down on the injected area for three to four hours.
• You may resume your normal diet.
• Do not engage in strenuous activity.
• Do not take a bath, swim or use the hot tub for at least 24 hours; you may take a shower.
• You may remove the plaster in the evening before you go to bed.

SIDE EFFECTS OF BOTOX INJECTION

• Temporary bruising around the injection site.
• Headaches, which resolve in 24 to 48 hours, can occur.
• Temporary muscle weakness in the area or near injection site.
• Dizziness. Lying down usually helps relieve dizziness, since it is frequently caused by a decrease in your blood pressure. Gradually sit up and then stand after at least 10 minutes of sitting.
• Mild headache. Drink plenty of fluid and take pain medication, as directed. If the headache continues or becomes severe, contact your physician or go the nearest Emergency Room.
• Mild discomfort on injection site when the local anesthetic wears off. This usually lasts two or three hours. If it occurs, apply ice to the area the day of the procedure and moist heat the day after the procedure if the discomfort persists.

WHEN SHOULD I CALL FOR HELP?

Contact your physician or come to the nearest Emergency Room if you have any of the problems stated below. Inform the Emergency Room staff that you just had an epidural injection. The physician must evaluate you for the injection complication.

• If the weakness and numbness of your arms, legs or feet does not resolve after eight hours.
• Increased pain on injection site even after applying ice or moist heat pack.
• Increased headache that does not resolve with conservative treatment.
• Onset of new fever, chills, nausea and vomiting.
• If you have uncontrolled blood sugar or blood pressure.
• Inability to control bowel or bladder.
• Inability to void after eight hours.