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| |  Adding Lidocaine to Radioisotope Injection Reduces Pain in SLN Mapping Procedure NEW YORK -- August 5, 2009 -- The addition of lidocaine to radiocolloid injection for sentinel- lymph-node (SLN) mapping in patients with early breast cancer reduces injection pain and improves patient comfort without compromising SLN identification, and should be introduced as standard practice. These are the conclusions of a study published online first and appearing in the September edition of The Lancet Oncology. Although shown to be effective, a radiocolloid injection is a painful procedure for which there is currently no effective pain management. To investigate methods of pain control, Alexander Stojadinovic, United States Military Cancer Institute, Washington, DC, and colleagues conducted the first randomised trial to assess whether pH modification of the radioisotope formulation with sodium bicarbonate or addition of lidocaine could reduce injection pain in patients undergoing SLN mapping. The authors assessed 121 patients with early stage breast cancer who were randomly assigned to receive either the standard topical 4% lidocaine cream and standard radiocolloid injection (n = 28), or topical placebo cream and radiocolloid injection containing either sodium bicarbonate (n = 31), 1% lidocaine (n = 32), or sodium bicarbonate and 1% lidocaine (n = 30). Immediately after the injection patients were asked to report the pain experienced at the time of injection using a pain rating scale and a pain intensity questionnaire. Overall, findings showed a significant reduction in pain reported in the 2 groups of patients whose injection contained 1% lidocaine, without significantly affecting the success of SLN identification. However, pH modification of the radioisotope solution showed no additional benefit compared with the standard preparation. Mean score on the pain rating scale (0 = no pain and 10 = most pain) was 6.0 for the standard care group, 4.7 for the sodium bicarbonate group, 1.6 for the 1% lidocaine group, and 1.6 for the sodium bicarbonate plus 1% lidocaine group. Mean pain rating intensity according to the questionnaire (0-78) was 17.5 for the standard care group, 15.4 for the sodium bicarbonate group, 4.6 for the 1% lidocaine group, and 3.4 for the sodium bicarbonate plus 1% lidocaine group. "For centres that use standard radiocolloid injections for SLN mapping in patients with early breast cancer…adding 1% lidocaine can significantly improve patient comfort…and should be considered a new standard of practice." SOURCE: The Lancet Oncology
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