A Four-Arm Randomized Clinical Trial of Topical Pain Control for Sentinel Node Radiotracer Injections in Patients with Breast Cancer

• Published in: Annals of surgical oncology Vol. 31; no. 7; pp. 4487 - 4497
• Main Authors: Wiener, Alyssa A., Schumacher, Jessica R., Perlman, Scott B., Wilke, Lee G., Lautner, Meeghan A., Bozzuto, Laura M., Hanlon, Bret M., Neuman, Heather B.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.07.2024; Springer Nature B.V
• Subjects: Administration, Topical; Adult; Aged; Anesthetics, Local - administration & dosage; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Oncology; Female; Follow-Up Studies; Humans; Ice; Lidocaine; Lidocaine - administration & dosage; Lymph nodes; Medicine; Medicine & Public Health; Middle Aged; Nuclear medicine; Oncology; Pain; Pain - drug therapy; Pain - etiology; Pain - prevention & control; Pain Management - methods; Pain Measurement; Patient satisfaction; Patients; Prognosis; Radioactive tracers; Radiopharmaceuticals - administration & dosage; Sentinel Lymph Node - pathology; Sentinel Lymph Node Biopsy - methods; Surgery; Surgical Oncology; Breast cancer; Randomized trial; Topical; Pain; Sentinel lymph node
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15235-7

Background Radioactive tracer injections for breast cancer sentinel lymph node mapping can be painful. In this randomized trial, we compared four approaches to topical pain control for radiotracer injections. Methods Breast cancer patients were randomized (9 April 2021–8 May 2022) to receive the institutional standard of ice prior to injection ( n  = 44), or one of three treatments: ice plus a vibrating distraction device (Buzzy ® ; n  = 39), 4% lidocaine patch ( n  = 44), or 4% lidocaine patch plus ice plus Buzzy ® ( n  = 40). Patients completed the Wong-Baker FACES ® pain score (primary outcome) and a satisfaction with pain control received scale (secondary). Nuclear medicine technologists ( n  = 8) rated perceived pain control and ease of administration for each patient. At study conclusion, technologists rank-ordered treatments. Data were analyzed as intention-to-treat. Wilcoxon rank-sum tests were used to compare pain scores of control versus pooled treatment arms (primary) and then control to each treatment arm individually (secondary). Results There were no differences in pain scores between the control and treatment groups, both pooled and individually. Eighty-five percent of patients were ‘satisfied/very satisfied’ with treatment received, with no differences between groups. No differences in providers’ perceptions of pain were observed, although providers perceived treatments involving Buzzy © more difficult to administer ( p  < 0.001). Providers rated lidocaine patch as the easiest, with ice being second. Conclusion In this randomized trial, no differences in patient-reported pain or satisfaction with treatment was observed between ice and other topical treatments. Providers found treatments using Buzzy ® more difficult to administer. Given patient satisfaction and ease of administration, ice is a reasonable standard.