Expert: Ronald Levy, M.D. - 7/5/2008

Question
Dear Dr. Levy, This is a follow up to the question I asked about my aunt who had the painful sentinel node biopsy. You said that there was just some stinging or burning with the procedure, yet when I asked her about it the next day, she was telling me about it, then suddenly stopped and said,"I can't talk about it, I can't even think about it." This upset me very much because I love my aunt and didn't understand why she had to go through this. Her surgeon had not even informed her that she was going to have this done. A nurse came in and took her up to nuclear medicine while she was in the one of the rooms already prepared to be taken to surgery. Then, I happened to find this post two nights ago written by a young wife and mother who had the same thing done. "I have just experienced the worst pain ever. Thankfully,it is over with. When my husband and I arrived this morning, I was taken to Nuclear Medicine. This is a scary place. I was warned prior to my procedure that it would be the worst part of the entire day. I couldn't imagine how with surgery scheduled the same day. I now understand why they warned me although I don't think anything could have prepared me for the pain I just experienced. My doctor came in to to see me and explained that they do not give a local anesthetic because it can interact with the "radioactive dye" that they inject. What am I supposed to do with that information? Obviously I had no choice so we proceeded. The initial stick was not that big of a deal. However, when he began injecting the dye, I thought I was going to come up off the table. I'm pretty sure that I was screaming, or at least moaning. I also remember saying that I thought I was going to pass out. In fact, I think I may have said a prayer that I would pass out. Once the needle was out, the pain only lasted a few more seconds (long seconds) and eventually subsided.  also. Neither my aunt nor this young woman had any kind of local to numb them, yet I have read stories online where some women having the same exact procedure are given a   local anesthetic. I am aware that this procedure only takes a short time, but my aunt had four long needles ran into her nipple and she told me it felt like each one went all the way to the back of her chest. She said that a young woman told her she would hold onto her while she had this procedure done, and my aunt said she was almost covering me she held me so tightly. I just don't understand why they would put my aunt and this other young woman through this if they could have given them something to numb them which is why I asked you if the procedure could have been done under general anesthesia. Thank you for your patience.

Answer
Now I am a little confused. As I recall the original letter, it described intense pain with the injection of the radionucleide for a nuclear medicine study (a radiologic study that sees where the dye goes). This is usually not painful. Now you describe a sentinal node biopsy (which is done in the axilla) and also talk about long needles in the breast (which sounds like a needle localization of a breast mass). Each of these is a different procedure with differing levels of pain. Before I answer this question incorrectly, please clarify which procedure(s) she had.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston