Administration of Subcutaneous Buffered Lidocaine Prior to Breast Lymphoscintigraphy Reduces Pain Without Decreasing Lymph Node Visualization

Abstract

and 2 Alaska Radiology Associates, Anchorage, AlaskaBreast lymphoscintigraphy using 99m Tc-sulfur colloid ( 99m Tc-SC) is well established in clinical practice for staging patients with breast carcinoma. Nearly all patients report having pain during the procedure. However, techniques used to minimize pain during breast lymphoscintigraphy are highly variable across institutions. Our study was to determine whether anesthetizing the skin with sodium bicarbonatehether-buffered lidocaine before performing breast lymphoscintigraphy reduced the pain experienced by the patients. The second objective of this study was to evaluate whether anesthetizing the skin with buffered lidocaine changed visualization of lymph nodes. Methods: This prospective, patient-masked and randomized study involved performing breast lymphoscintigraphy in a control group and experimental group of female breast cancer patients. The control group did not receive skin anesthetic before 99m Tc-SC injections, whereas the experimental group first underwent skin anesthesia with an injection of 2% sodium bicarbonate-buffered lidocaine. All patients were asked to rate their pain levels, using the National Institutes of Health pain scale, before the procedure and immediately after the injections. The change in pain from baseline was compared between the 2 groups. After the injections, scintigraphic imaging of the axilla was performed, and the number of axillary lymph nodes visualized was recorded. Results: No significant difference was found in preprocedural baseline pain from the control group, compared with the experimental group. There was a statistically significant difference in the increase in pain experienced during the procedure between the control group and the experimental group (P 5 0.009). There was no significant difference in the detection of lymph nodes between the control and experimental groups (P 5 0.56). Conclusion: The results from our study indicate that injecting subcutaneous buffered lidocaine before intradermal injection of 99m Tc-SC for breast lymphoscintigraphy significantly decreases patient pain without interfering with lymph node visualization.

Comparison of Post-injection Site Pain Between Technetium Sulfur Colloid and Technetium Tilmanocept in Breast Cancer Patients Undergoing Sentinel Lymph Node Biopsy

“… 2 Hawkins et al found that a separate injection of lidocaine prior to intradermal injection with TcSC decreased patient pain. 12 Another study by O’Connor et al had patients apply topical anesthetic creams prior to TcSC injection. 3 They did not find benefit with the anesthetic creams; however, patients were not asked about their pain until 2–4 days after the procedure.…”

Consecutive Case Series of Melanoma Sentinel Node Biopsy for Lymphoseek Compared to Sulfur Colloids

“…The results from this study indicate that Lymphoseek  ( 99 Tc-tilmanocept) is able to identify sentinel nodes in patients undergoing lymphoscintigraphy for melanoma in a shorter amount of time and with less radioactivity than patients mapped with 9 Tc-Sulfur Colloid.…”

The Use of Periareolar Topical Lidocaine Jelly After Needle Localization May Reduce Pain of Subsequent Lymphoscintigraphy

“…However, a randomized control trial conducted by Canning et al found no significant difference between pain scores in the group that received a topical combination of lidocaine and prilocaine and the control group [7]. Hawkins et al found that the use of subcutaneous injection of sodium bicarbonate buffered lidocaine before the injection of the radiopharmaceutical agent reduced pain as well [8].…”