Inclusion Criteria:  Willing to provide written informed consent Willing to comply with all study procedures and be available for the duration of the study Documented diagnosis of R-CECS determined with elevated compartmental pressure testing following lower extremity fascia release (fasciotomy or fasciectomy)  Females of childbearing potential must have a negative urine pregnancy test prior to enrollment and agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to randomization, for the duration of study participation, and for 7 days following completion of therapy.  A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:  Has not undergone a hysterectomy or bilateral oophorectomy; or Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).  Exclusion Criteria:  History of hypersensitivity or allergy to any of the study drugs or drugs of similar chemical classes Known neuromuscular disease Known pulmonary disease including but not limited to asthma, pneumonia, or upper respiratory tract infection Dysphagia Known cardiac disease including but not limited to congestive heart failure, arrhythmia, or history of myocardial infarction Enrolled in another clinical trial or has used of any investigational drugs, biologics, or devices within 30 days prior to enrollment Currently or have taken in the past medications that affect neuromuscular function, aminoglycosides, muscle relaxants, or other botulinum neurotoxin agents. Currently taking any blood-thinning medications including, but not limited to Plavix, Coumadin, Eliquis, Xarelto Women who are pregnant or breast-feeding Vulnerable populations Not suitable for study participation due to other reasons at the discretion of the investigator