psd-502 and Thyroid-Nodule

Thyroid fine needle aspiration biopsy (TFNAB) is the gold standard in the differential diagnosis of the thyroid nodules. In general, no analgesia is needed before this procedure. However, it is usually believed that the patients may be more comfortable if the procedure is performed under local anaesthetics. In this study, we examined the impact of the use of dermal anaesthetic on the patient's level of discomfort during palpation-guided TFNAB.. Fifty female patients with nodular goitre were enrolled in this study. Patients were randomised into two groups: a placebo cream was applied to group 1 patients (25 females; mean age 47.45 +/- 11.61 years), and local anaesthesia (EMLA 5% cream) was applied to group 2 patients (25 females; mean age 50.89 +/- 12.01 years) approximately 1 h before TFNAB. All patients were asked to mark the pain they felt during the TFNAB on Visual Analogue Scale.. The pain scores during TFNAB were 27.73 +/- 20.01 mm and 24.79 +/- 21.98 mm in the placebo group and in the EMLA group respectively. There was no significant difference between the groups (p = 0.496).. Topical anaesthesia before palpation-guided TFNAB provides no benefit.

Topics: Administration, Cutaneous; Adult; Analgesics; Anesthesia, Local; Anesthetics, Local; Biopsy, Fine-Needle; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Middle Aged; Pain; Pain Measurement; Palpation; Prilocaine; Thyroid Nodule

Pain is one of the few drawbacks of fine-needle aspiration biopsy (FNAB) in patients with nodular thyroid disease (NTD). Lidocaine/prilocaine cream, an eutectic mixture of local anaesthetics (EMLA), is a frequently used topical anaesthetic. Despite its well-documented efficacy for the relief of pain associated with other cutaneous procedures that involve needle insertion, the analgesic role of EMLA has not been previously reported in patients with NTD who are undergoing FNAB. The aim of this study was to determine the analgesic efficacy of EMLA for FNAB-associated pain in patients with NTD.. Double-blind, placebo-controlled clinical trial.. The study was conducted at a thyroid outpatient clinic. We studied 99 patients with NTD.. Patients with NTD were allocated to receive either 2.5 g of EMLA (n = 50) or placebo (n = 49) 60 min before ultrasonographically guided FNAB. A series of four biopsies of each nodule was performed. Patients rated pain associated with the procedure according to a 100-mm visual analogue scale (VAS), an 11-point numeric rating scale (NRS), and 4-category verbal rating scale (VRS).. When the EMLA group was compared with the placebo group, there were no significant differences with respect to age, sex, thyroid volume, nodule size or nodule site. Significant differences were noted in the pain ratings of the two groups according to all three pain scales. When the effectiveness of EMLA was compared with that of placebo, the mean VAS score was 25.0 +/- 22.3 mm vs. 40.0 +/- 30.5 mm (P = 0.006) and the mean NRS score was 2.9 +/- 2.3 points vs. 4.0 +/- 2.6 points (P = 0.02). The absolute numbers according to VRS score in each group was also significantly different (P = 0.01). Although our sample size was small, the data suggest that FNAB-associated pain was sex-related and that women were significantly more sensitive than were men (P = 0.003 for VAS score and P = 0.001 for NRS score). No adverse effects from the use of EMLA were reported.. To our knowledge, this is the first study demonstrating that a topical anaesthetic, EMLA, provides an effective and noninvasive analgesia during the FNAB of NTD.

Topics: Adult; Anesthetics, Combined; Anesthetics, Local; Biopsy, Fine-Needle; Chi-Square Distribution; Double-Blind Method; Female; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Ointments; Pain Measurement; Prilocaine; Sex Distribution; Thyroid Gland; Thyroid Nodule; Ultrasonography

Quality of life is an important issue in endocrine tumors because of the high prevalence of benign tumors and the indolent course of most malignant tumors.. To evaluate the frequency and the intensity of pain and anxiety in patients undergoing thyroid nodule fine-needle aspiration cytology (FNAC) and to identify factors associated with pain.. Single center prospective study in the setting of a one-stop outpatient diagnostic clinic for thyroid nodules. Pain was evaluated using a 100-mm visual analogue scale (VAS) immediately following (VAS1) and 30 minutes after (VAS2) FNAC and was considered significant if ≥ 30. Anxiety symptoms were assessed prior to FNAC using a self-report measure questionnaire: the state form of Spielberger State-Trait Anxiety Inventory (STAI, form Y-A). FNAC was performed with a 25-gauge needle and a moderate aspiration and two passes for each nodule.. Two hundred eighteen consecutive patients (163 females, 55 males; mean age 53 years, range 12-84 years) undergoing FNAC of one to three nodules were included. VAS1 was ≥ 30 in 24% of the patients and VAS(2) was ≥ 30 in 13% of the patients. Independent significant factors correlated to a VAS1 of ≥ 30 were age under 25 years and the number of nodules being biopsied. Independent significant factors correlated to a VAS2 of ≥ 30 were VAS1 ≥ 30 and female sex. No correlation was found between pain and nodule size or nodule depth, nor the duration of application of the eutectic mixture of local anesthetics (EMLA) patch prior to FNAC. The mean STAI score for anxiety was 37 ± 12. The average STAI score was significantly higher in women (39) than in men (33; p = 0.01). There was no significant correlation between STAI score and age under 25 years, previous FNAC, number of nodules biopsied, or acetaminophen administration, but the STAI score was significantly correlated to VAS1 and VAS2.. FNAC-related pain is frequent and correlates with the number of nodules biopsied, age under 25 years, female sex, and anxiety.

Topics: Acetaminophen; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Care Facilities; Analgesics, Non-Narcotic; Anesthetics, Combined; Anesthetics, Local; Anxiety; Biopsy, Fine-Needle; Child; Female; France; Humans; Lidocaine; Lidocaine, Prilocaine Drug Combination; Male; Middle Aged; Pain; Pain Measurement; Predictive Value of Tests; Prilocaine; Prospective Studies; Risk Factors; Sex Factors; Surveys and Questionnaires; Thyroid Gland; Thyroid Nodule; Young Adult