LETTER TO THE EDITOR
Local Anesthesia in Stereotactic,
Vacuum-Assisted Breast Biopsy
To the Editor:
Local anesthesia is necessary in stereotactic-guided
vacuum-assisted breast biopsy (SVAB) to minimize the
pain due to the skin incision, the introduction of a 14-
or 11-gauge probe, and in obtaining the tissue samples.
In order to optimize the administration of local anes-
thetic, the use of buffered lidocaine decreases the dis-
comfort of anesthesia infiltration by neutralizing the
acidic pH of lidocaine and thereby decreasing or elimi-
nating the “sting” (1–3). Buffered lidocaine must be pre-
pared at the time of administration due to the instability
of the buffering after several hours (4). However, as pre-
viously reported by Dempsey and Rubin (5), preparing
the solution just prior to injection is not time consuming
(10 seconds at most). In our clinical practice we have
observed an improvement in local anesthesia delivery by
placing a small amount of lidocaine in the specimen
chamber of the SVAB probe (Fig. 1). By doing this, a
Figure 1. The specimen collection chamber is filled with a solu-
tion of 1% lidocaine with 1:100,000 epinephrine neutralized
with 8.4% sodium bicarbonate.
© 2001 Blackwell Science Inc., 1075-122X/01/$15.00/0
The Breast Journal, Volume 7, Number 1, 2001 72–73
small bolus of lidocaine is administered precisely to the
area to be biopsied during the probe’s firing. Secondly,
by modifying the needle configuration by bending it to
90 degrees, easier access and administration of lidocaine
along the shaft of the biopsy probe is achieved (Fig. 2).
Without bending the needle, the tract of the needle is ob-
lique to the course of the biopsy probe (Fig. 2). As the
needle is withdrawn, a small amount of lidocaine is in-
jected along the entirety of the needle tract (Fig. 3). A to-
tal of 1.5–2 cc of lidocaine is used for both raising of the
wheal as well as injection of local anesthetic along the
course of the biopsy probe.
Rachel F. Brem, MD
Joelle M. Schoonjans, MD
The George Washington University
Washington, DC
Figure 2. (a) The 20-gauge needle for administration of deeper
anesthesia is bent. (b) Bending of the biopsy needle for anesthe-
sia injection allows for administration of anesthesia along the
course of the biopsy probe (A). Without bending the needle, an-
esthesia cannot be injected along the biopsy probe, and admin-
istered anesthesia is distant from the biopsy site (B).

Figure 3. As the needle is removed, the anesthetic is injected. A
total of 1–2 cc of anesthetic solution is used. Administration of
greater volume of anesthetic is not recommended as it may ob-
scure the lesion.
Letter to the Editor • 73
REFERENCES
1. Masters JE. Randomised control trial of pH buffered li-
gnocaine with adrenaline in outpatient operations. Br J Plast
Surg 1998;51:385–87.
2. Fitton AR, Ragbir M, Milling AP. The use of pH ad-
justed lignocaine in controlling operative pain in the day sur-
gery unit: a prospective, randomised trial. Br J Plast Surg 1996;
49:404–8.
3. Palmon SC, Lloyd AT, Kirsh JR. The effect of needle
gauge and lidocaine pH on pain during intradermal injection.
Anesth Analg 1998;86:379–81.
4. Larson PO, Ragi G, Swandby M, Darcey B, Polzin G,
Carey P. Stability of buffered lidocaine and epinephrine used
for local anesthesia. J Dermatol Surg Oncol 1991;17:411–14.
5. Dempsey PJ, Rubin E. Preoperative needle localization
in the breast: utility of local anesthesia. Comm Radiol 1993;
189:623–24.