Galactography without discomfort using lidocaine/prilocaine anesthetic cream

Abstract

Galactography (ductography) is the technique of choice for studying pathologic nipple discharge. It is sometimes difficult or even impossible to perform cannulation of the ductal orifice because of the discomfort caused to the patient. To evaluate the efficacy of a eutectic mixture of local anesthetics (EMLA) containing lidocaine and prilocaine applied as a cream to reduce discomfort during galactography. 46 patients with abnormal nipple secretion underwent galactography. The patients were distributed in non-randomized form into two groups (A and B). Group A consisted of 19 patients who were treated without application of the anesthetic cream; group B consisted of 27 patients to whom the anesthetic cream was applied prior to galactography. Pain intensity was measured using a verbal description scale. Galactography was successfully performed in all cases in group B (n = 27) and in 15 cases (78.9%) in group A. In four patients from group A, it was initially impossible to cannulate the discharging duct because of patient discomfort and anxiety. The same patients were submitted to galactography 1 week later after application of the anesthetic cream to the areola/nipple area. In total, then, 31 cases (all 27 of group B plus four) registered 0 ( = no pain) on the verbal description scale after application of the cream. In the 19 patients of group A, the degree of pain registered was mild in 11 cases and discomforting in eight cases. The application of anesthetic cream over the areola/nipple area enables galactography to be performed without patient discomfort. It also reduces anxiety, allowing the radiologist to perform the procedure with confidence and safety, and without stress on the part of the patient or radiologist.