Sentinel node biopsy - do I need Emla cream?

I was very afraid of this procedure...more than the BMX and DIEP flap scheduled for the next day! I asked my BS for RX for EMLA and used it one hour before with Tegaderm over both nipples. I felt some very slight stinging discomfort, but that was it. He injected several times into both areolas. I was so relieved!! Actually, I was totally distracted by the really handsome young radiologist who injected me. He couldn't have been more than16 years old.... :0

Interesting the difference in protocols. My sentinel node injections were done the morning of surgery. I never gave a moment's thought to what would be involved, and simply thought it would be more needles and probes in the breast. The only significant memory was a little commentary on the challenges with my dense breast. I smiled, and stated that after that day, I would never again be hearing about dense breasts. The technician really felt badly for me, and just sighed. But I didn't experience anything better or worse than in any of the biopsies in the weeks prior.

I was so lucky....they did all the sentinel biopsy as part of my lumpectomy. I don't understand why it has to be a separate procedure.

Years before I had my lumpectomy, I had an excisional biopsy where they did put a wire...this was done as I was sitting in a chair...now there was NO pain but as soon as I got out of the chair I almost passed out. Scared the doctor....I guess no one else had done this.

So good luck everyone and it sounds as if the Emla creme really, really helps.

If you have it available, why not? I hadn't had any txt prior and was on my way to surgery. My technician was great....no pain, but I have heard many others that did. Good luck.

YEP...DO IT!!!

Check with your doc. I was not allowed to use EMLA before these procedures.

based on what I had read on these boards, the part of the Lx that I was dreading the most was the wire insertion, dye insertion, etc. My worry wasn't lessened by the fact that while the tumor biopsy went ok in terms of pain, I bled from it A LOT and bruised quite a bit. My tumor was right under my nipple (which was removed during the Lx) so it was in a particularly sensitive area. I mentioned my concern to bs at pre-op and was assured that lots of lidocaine would be used. I mentioned again in the radiology room before radiologist started the procedure for wire insertion. He again assured me that he'd use lots of lidocaine and said bleeding from this procedure tended to be much less than from biopsy, but that he appreciated that additional information.

And, as it turned out, they were right and I wondered why I had worried so much. The mammogram guided wire insertion went just fine. No pain or discomfort at all other than the initial prick when they shot me full of lidocaine. In fact, the radiologist kept saying 'you might feel some tugging or pressure now'...but honestly, I didn't even feel that. All I could feel was the nurse holding my hand :-) The worst part was that the same nurse who held my hand was the chatty type, bless her, and I just wanted to tell her to shut up so I could just breathe (but I didn't, she was sweet and meant really well, and her chatting was quite annoying but didn't hurt, and pain was my fear!_

As for the dye, the bs did that herself after I was out on the operating table, so that wasn't an issue either.

I still don't know what EMLA is, but whatever it is, I didn't need it. Honestly, my advice would be to TALK to your Treatment providers and tell them what you need to be comfortable! Once I was told that there would be lots of lidocaine, I had no intention of letting them do ANYTHING before that lidocaine took effect, and that worked for me. It could save you a lot of anxiety and worry to talk with them and ask directly what to expect and what they will do about pain.

Do whatever you feel you need to in order to make this easier on yourself. No sense having anxiety over this or suffering pain needlessly. If you're concerned about pain, request the EMLA. Women's reports of the painfulness of the injection(s) run the entire spectrum from very little pain to sheer agony. After some of the nastiness you've been through with chemo and SEs, I would be surprised if this would register that much in comparison, but why risk it, or suffer from pain when there's a remedy.

Many BSs use both a radioactive tracer and blue dye to map the sentinel node(s). Some use only one. Radio tracers are injected prior to surgery, either the morning of, or the afternoon before surgery.Standard procedure is for the BS to inject blue dye intra-operatively. Most injections are done intradermally at the site overlying the tumour or superficially at the peri-areolar margin. Many bco women report receiving 4 peri-areolar injections. I had a single peri-areolar injection, so technique varies by cancer center and the nuclear tech/radiologist injecting the tracer. A deep peri-tumoural injection will be used if internal mammary node (not the axillary nodes) drainage is suspected. There is some variance in radiocolloids used by country, although Technetium-99m sulfur colloid (Tc-99) is the most universally used and what you will likely receive. It's half life is 6 hours, so surgery must occur within 24 hours. If you receive it the morning of surgery, you will be injected with a lesser volume. When you receive it the afternoon before surgery, you must receive a greater quantity, as the radioactivity reduces by half every 6 hours. ( ½ potency 6 hours after injection; ¼ 12 hours after injection; 1/8 18 hours after injection; this means they have to give you more when you receive it the day before surgery to ensure sufficient radioactivity during your SNB procedure). I did not have any numbing agent and didn't think the injection was that bad. Degree of anxiety leading up to the injection, individual pain tolerance and personal use of pain meds will all be factors. A key factor that you can't anticipate is the injection technique of the practitioner. My nuclear tech was so gentle and kind. I found the movement of the radio tracer in my breast uncomfortable, but not unbearable by any means. My injection was administered the morning of surgery, so I received a lower volume. A gamma camera checked for a hot node before I left the room. Your BS will use a gamma probe to locate the hot node(s) in the OR.

Good luck and hope this is uneventful for you.

I was told by the radiology folks that EMLA and lidocaine can change some aspects of the process. I don't remember now whether it was the dye uptake or some other thing they needed to control. It wasn't bad without EMLA or lidocaine--much more comfortable than either biopsy.

Yes, above I mentioned talking to a nurse or tech, but it was a doctor who came in to give me the injection.