title: Application of a topical vapocoolant spray decreases pain at the site of initial intradermal anaesthetic injection during ultrasound-guided breast needle biopsy.
abstract: OBJECTIVE
  To assess whether the application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy decreases pain at the site of the initial injection.
  
  
  METHODS
  In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study, 50 women aged 49.1 ± 1.6 years (mean ± standard error) were recruited and provided written informed consent. Participants served as their own controls and were blinded as to whether a topical vapocoolant spray or a placebo was used immediately prior to the initial local anaesthetic injection at two separate biopsy sites. With the exception of the application of vapocoolant or placebo, the entire ultrasound-guided procedure was performed according to a routine protocol. Participants recorded pain at initial injection site on a visual analogue scale. General linear mixed models for repeated measures analysis of variance and a 0.05 significance level were used.
  
  
  RESULTS
  Application of topical vapocoolant spray was shown to significantly decrease pain at the site of initial intradermal anaesthetic injection as compared to placebo (p<0.001). Treatment effect was independent of age of the subject, race/ethnicity, operator, type of biopsy device, and histopathology result. No complications from vapocoolant spray use were reported.
  
  
  CONCLUSIONS
  Application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy significantly decreases pain at the site of the initial injection and could contribute to improve the patient's overall procedural experience.
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12 Ave., Miami, FL 33136, USA. Electronic address: fcollado@med.miami.edu.
authors.forename: F
authors.initials: F
authors.lastname: Collado-Mesa
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12 Ave., Miami, FL 33136, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Net
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, 1475 NW 12 Ave., Miami, FL 33136, USA.
authors.forename: K
authors.initials: K
authors.lastname: Arheart
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12 Ave., Miami, FL 33136, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Klevos
authors.affiliation: Department of Radiology, University of Miami Miller School of Medicine, 1475 NW 12 Ave., Miami, FL 33136, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Yepes
mesh_terms: D000287:Administration, Topical; D000700:Analgesics / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000009:adverse effects*; D001941:Breast Diseases / Q000175:diagnosis* / Q000473:pathology; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D007271:Injections, Intradermal / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D018084:Ultrasonography, Interventional
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local