Severe Childhood Obesity Has Tripled

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					     Addition of Anesthetic to Radioisotope
     Injection Reduces Pain
            he addition of lidocaine to radiocolloid   States Military Cancer Institute, Washington,      ing the success of SLN identification.

     T      injection for sentinel lymph-node
            (SLN) mapping in patients with early
     breast cancer reduces injection pain and
                                                       D.C., USA, and colleagues conducted the
                                                       first randomized trial to assess whether pH
                                                       modification of the radioisotope formulation
                                                                                                          However, pH modification of the radioiso-
                                                                                                          tope solution showed no additional benefit
                                                                                                          compared with the standard preparation.
     improves patient comfort without compro-          with sodium bicarbonate or addition of the             Mean score on the pain rating scale (0 no
     mising SLN identification, and should be          anesthetic lidocaine could reduce injection        pain and 10 most pain) was 6.0 for the stan-
     introduced as standard practice, concluded        pain in patients undergoing SLN mapping.           dard care group, 4.7 for the sodium bicar-
     an article published online first and in the          The authors assessed 121 patients with         bonate group, 1.6 for the 1 percent lidocaine
     August edition of the Lancet Oncology.            early stage breast cancer who were randomly        group, and 1.6 for the sodium bicarbonate
         Sentinel-lymph-node (SLN) mapping and         assigned to receive either the standard topical    plus 1 percent lidocaine group. Mean pain
     biopsy are used to determine how far cancer       4 percent lidocaine cream and standard             rating intensity according to the question-
     has progressed into the lymph nodes in early      radiocolloid injection (28), or topical placebo    naire (0 ) was 17.5 for the standard care
     stage breast cancer. A radioactive colloid        cream and radiocolloid injection containing        group, 15.4 for the sodium bicarbonate
     and/or blue dye are injected into the area of     either sodium bicarbonate (31), 1 percent          group, 4.6 for the 1 percent lidocaine group,
     the tumor and follow the path that tumor          lidocaine (32), or sodium bicarbonate and 1        and 3.4 for the sodium bicarbonate plus 1
     cells are most likely to take from the tumor      percent lidocaine (30). Immediately after the      percent lidocaine group.
     to the lymph nodes. The nodes that initially      injection patients were asked to report the            The authors concluded: “For centres that
     absorb the dye, the sentinel nodes, are           pain experienced at the time of injection,         use standard radiocolloid injections for SLN
     removed and biopsied. Although shown to           using a pain rating scale and a pain intensity     mapping in patients with early breast
     be effective, a radiocolloid injection is a       questionnaire.                                     cancer…adding 1 percent lidocaine can
     painful procedure for which th
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