Zografos George C, Zagouri Flora, Sergentanis Theodoros N, Gounaris Antonia, Pararas Nikolaos, Oikonomou Vassiliki, Panopoulou Effrosyni, Fotiadis Constantine, Bramis John
First Department of Propaedeutic Surgery, Hippokratio Hospital, University of Athens, Athens, Greece.
Surg Today. 2008;38(10):886-9. doi: 10.1007/s00595-007-3725-z. Epub 2008 Sep 27.
Ductal endoscopy is valuable for the differential diagnosis of bloody nipple discharge; however, the pain associated with this procedure has not been evaluated. This study aims to assess the pain experienced by patients during ductal endoscopy.
We studied a consecutive series of women who underwent ductal endoscopy, to investigate the cause of bloody nipple discharge. The procedure was performed using standard local anesthesia (lidocaine 1% 10 ml without epinephrine, involving nipple block and periaureolar administration). Patients were asked to score the level of pain with a visual analog scale, 1, 4, 7, 12, 17, 22, 27, and 32 min after the procedure, and describe their overall and maximum pain.
This series comprised 20 women aged from 27 to 68 years old. The overall pain (mean +/- SE) score was equal to 5.8 +/-0.3, and the maximum pain score was 8.3 +/- 0.2. The peak of pain corresponded with when the dilator was inserted through the sphincter. The group in which the dilator was inserted after 4 min experienced more intense maximum and overall pain after 7, 12, 17 and 22 min.
Pain is an important factor in ductal endoscopy, and peaks relatively early. A standard, baseline local lidocaine dose of greater than 10 ml may be necessary at the beginning of the procedure. Late insertion of the dilator seems to be an indicator of the force of the procedure.
导管内镜检查对于血性乳头溢液的鉴别诊断具有重要价值；然而，该操作所伴随的疼痛尚未得到评估。本研究旨在评估患者在导管内镜检查过程中所经历的疼痛。
我们对一系列连续接受导管内镜检查以探究血性乳头溢液病因的女性进行了研究。该操作采用标准局部麻醉（1%利多卡因10毫升，不含肾上腺素，包括乳头阻滞和乳晕周围给药）。要求患者在操作后1、4、7、12、17、22、27和32分钟时，使用视觉模拟量表对疼痛程度进行评分，并描述其总体疼痛和最大疼痛程度。
该系列研究包括20名年龄在27至68岁之间的女性。总体疼痛（平均值±标准误）评分为5.8±0.3，最大疼痛评分为8.3±0.2。疼痛高峰与扩张器通过括约肌插入时相对应。在4分钟后插入扩张器的组在7、12、17和22分钟后经历了更强烈的最大疼痛和总体疼痛。
疼痛是导管内镜检查中的一个重要因素，且在相对较早阶段达到峰值。在操作开始时，可能需要标准的、大于10毫升的基线局部利多卡因剂量。扩张器插入较晚似乎表明操作力度较大。
