Topic: Wire Excision biopsy painkillers

This was published today in the Dr's Guide Media Review

 Preoperative topical 4% liposomal lidocaine (LLC) significantly decreases the perception of pain during sentinel lymph node (SLN) biopsy injections, without any compromise in lymph node identification, investigators reported here at the 9th Annual Meeting of the American Society of Breast Surgeons (ASBS 2008).

SLN biopsy is an essential component of breast cancer staging and requires that radioactive tracer technetium 99 sulfur colloid be injected into the periareolar area. This process is known to cause pain and anxiety among patients, according to researcher Daniela J. Schupp, MD, Surgery Fellow, Inova Fairfax Hospital, Falls Church, Virginia.

To determine the effect of LLC cream on pain and adverse effects, Dr. Schupp and colleagues performed a prospective, randomised, double-blinded study. They enrolled 42 patients aged 18 years or more who presented to the outpatient surgery centre and were not breastfeeding, had no lidocaine allergies, and had no prior periareolar surgeries.

Patients received either placebo or 4% LLC cream to their areola with a 1-cm margin prior to SLN injection.

The study's endpoint was perceived differences in anxiety and pain due to SLN injections as evaluated before the creams were applied and then within minutes after the injections as measured with a 2- to 10-point visual analogue scale. The researchers analysed the data using Wilcoxon rank tests.

Caucasian women comprised the majority of patients (88%), the average age was 55 years, and the average weight was 75.7 kg. None of the patients had signs of an allergic reaction to the creams. Participants received injections within a mean time of 32.2 minutes (SD, 12.2).

The difference in pain perception among the 20 patients in the LLC group and the 22 patients in the placebo group was statistically significant (P = .052). The lidocaine group reported a 1-point increase in median pain score from baseline (P = .002), and the placebo group had a 4-point median increase from baseline (P < .001).

"Anxiety is not affected by placebo or lidocaine cream application," Dr. Schupp noted in a presentation on May 3. Levels of anxiety before and after the injections were the same in the 2 groups, and there was 100% lymph node identification in both groups (P = .5).