Question re Stereotactic biopsy

Trying2staypositive

Hello all, I cant sleep so thought id post hoping for some insights from anyone that can share tomorrow. I am having a stereotactic biopsy using mammo (sitting up) this thurs for some microcalcifications. (Thats one of 2 issues sadly-need an mri also in a few weeks). Unfortunately I have heard some horror stories about pain during the stereotactic procedure despite local anesthetic but some others say its nothing. I am especially worried because I usually cannot tolerate local anesthetics with epinephrine...I have a heart condition. I probably should call and tell them in advance. (Didnt occur to me the day I made the appt). I know Epi prolongs the duration of the anesthetic though...im really worried the one with no epi could prematurely wear off during biopsy. Anyone have any input into how long it generally took to collect samples after the local injection? Im sure its a little different for everyone. Wondering if I should chance the epi reaction? I have svt and it may sustain as a result of epi. Mostly I just feel god awful and could pass out.

MelissaDallas

I think the epi is used along with the numbing in the injection to help control the amount of bleeding, not so much to extend the duration of the numbing. Talk to your doctor or the facility before your biopsy

Ingerp

It looks like epinephrine is used in local anesthesia as a vasoconstrictor, much like what's usually in novocaine at the dentist to help keep it in the local area. Trying2stay--my biopsies have been very quick, like a few minutes once they got going. It takes a while to get changed, get set up, get the local, but particularly if you only have one area they're looking at, it should go quickly. Of course tell your BS about it. I always got novocaine without the vasoconstrictor for dental work when I was pregnant. Not a big deal.

onceabird

I had a stereotactic, mammo-guided biopsy as well (mine was laying down). They did numb the surface but you do feel the needles inside. Have you ever had a nurse try to get a vein for blood draw but miss? It feels like that. It isn't horrible, and it only takes a few minutes.

djmammo

Trying2Stay

By all means tell them about your heart and they will use something without epi. Everyone stocks both with and without epi preparations of local.

====

I always asked patients if local anesthesia works adequately for them at the dentist as I have tended to see a correlation there. If it works or doesn't in the mouth its usually the same in the breast, again just my experience. If they tell me it works initially but seems to wear off too soon, I would use a longer acting local anesthetic, or a combination of long and short acting. We would sometimes have to order it from the pharmacy ahead of time as we did not usually stock the long acting ones.

The degree of variability of pain tolerance/pain threshold between patients is vast. Some cannot tolerate the sting of the local before it takes effect, while others have asked for no local anesthesia at all. It is likely in part genetic but it does seem to me at least that older patients that have already experienced a number of physically painful events in life like childbirth, kidney stones, other procedures, etc. have a better tolerance for pain than someone younger that is having their first such experience ever with the breast biopsy. A little anticipatory anxiety appears to add to the level of pain perceived, again just my opinion.

GenX

Trying2Stay - you may be on your way to or at your procedure now but my experience with stereotactic biopsy for calcifications was laying down and I can say with loads of confidence that the small burning/pinching sensation from the lidocaine injection was far less of an issue than the highly uncomfortable position they had me in for 20+ minutes. If you're not laying down, it's a win!

It appears that there is a lidocaine variant without epinephrine.

I, too, used to feel everything in my mouth at the dentist, no matter the number of anesthetic shots they would deliver...until I switched to a better dentist who knew how to numb the nerve area properly! Can't believe I didn't know to switch sooner. At any rate, with appropriate lidocaine injection technique, I imagine you will not feel the biopsy needle & it won't be a big deal. Good luck!

Trying2staypositive

Thanks so much everyone for your insights and responses! I truly appreciate all of you who took the time to write. I think my pain tolerance is fairly decent-Im generally ok with needles and procedures. Most doctors and dentists have told me over the years I am a very good patient. I only recently had the issue with the local (my heart condition has worsened with age) and since I havent needed dental work since, I have never had the local with no epi yet-but my dentist told me that she will no longer use it with me (since I had the heart reaction in her office but luckily I was laying down already so it was somewhat short lived). My cardiologist doesnt even like me taking decongestants so I figured probably a good idea to use the one without. Ive never had any issue with local working when the epi was in it-always has worked at the dentist and a few times for minor procedures. I was just mainly worried about the no epi version possibly wearing off faster or something. 😊 My biopsy is Thurs so maybe I will give them a call tomorrow and just give them a heads up.

djmammo

Trying2staypositive

I've never noticed a difference between the with and without epi for length of effectiveness. If you feel like its wearing off during the procedure tell them and they can give you more right through the biopsy needle without sticking you again.

Cowgirl13

I can't have anything with the epi so I get the one without (carbocaine). When I've had dental work done they sometimes have to shoot me up twice because the non-epi wears off faster. But I wouldn't worry, just tell them right away if you feel anything at all and they should be able to give you another injection. Don't be a hero about it. Take care of yourself.

Trying2staypositive

Thanks Djmammo and Cowgirl13! Will let you all know how it went after they finish tomorrow. Praying for benign results! Its going to take 5 business days....oh boy.