Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy

Purpose: This randomized, double-blind controlled study evaluated the effectiveness of sodium bicarbonate-buffered lidocaine on reducing pain during imaging-guided breast biopsies. Materials and Methods: This prospective, HIPAA-compliant study randomly assigned 85 women undergoing ultrasound-or stereotactic-guided core-needle breast biopsies to receive intradermally and intraparenchymally either 1% lidocaine buffered with sodium bicarbonate (9:1 ratio) (bicarbonate study group) or 1% lidocaine alone (control group). Pain was evaluated using,a 0-to -10 Likert pain scale during both intradermal and intraparenchymal anesthesia injections and during tissue sampling. Prebiopsy breast pain, anxiety, medical history, demographics, biopsy type, radiologist level of training, breast density, and lesion histology were recorded. Data were analyzed using analysis of variance and analysis of covariance. Results: Unadjusted mean pain scores were 1.47 and 2.07 (study and control groups, respectively; P =.15) during intradermal injections, and 1.84 and 2.98 (study and control groups, respectively; P =.03) during intraparenchymal injections. Tissue sampling mean pain scores were.81 and 1.71 (study and control groups, respectively; P =.07). Moderator analyses found (1) among patients with preprocedural pain, those in the bicarbonate group experienced less intradermal injection pain (0.85 +/- 1.23) than patients in the control group (2.50 +/- 2.09); (2) among patients with fatty or scattered fibroglandular tissue, those in the bicarbonate group (1.35 +/- 1.95) experienced less intraparenchymal injection pain than the control group (3.52 +/- 3.13); and (3) during ultrasound -guided biopsies, patients in the bicarbonate group experienced less tissue-sampling pain (0.23 +/- 0.63) than the control group (1.79 +/- 3.05). Conclusions: Overall, buffering lidocaine with sodium bicarbonate significantly reduced pain during intraparenchymal injections, and additional pain reduction was found in certain patient subgroups during intradermal injections, intraparenchymal injections, and tissue sampling.