Superiority of improvement in the verum group was also evident with respect to four explorative secondary parameters: SF-36 (quality of life), angle measurement (mobility of the knee), CGI (clinical global impression) and global assessment of efficacy by physicians and patients (p < 0.001 for each parameter). A total of 22 AEs occurred in 22 patients (7 in the active therapy group, 15 in the placebo group). No adverse drug reaction was reported in the active therapy group.
The ideal method for inducing local anesthesia before a cutaneousprocedure such as FNAB should be effective, fast, and portable. It should notdisrupt the usual department routine or cause an additional biologic orphysical risk to the patient. Previous reports have shown that bothneedle-free delivery of lidocaine and EMLA cream decreased the discomfort andpain related to FNAB when compared to placebo. The main disadvantage of EMLAcream is that EMLA must be applied a minimum of 1 hour before FNAB, which mayrender its use impractical in a busy clinic, whereas lidocaine, administeredby needle-free delivery, takes effect within 1-3 minutes. The rapid onset andease of use decrease the time associated with FNAB and enable the routine useof the needle-free delivery of lidocaine in busy clinics. Although both formsof topical anesthesia are effective, there has not been a direct comparisonof the needle-free delivery of lidocaine and EMLA cream. Minimal tissueswelling underlying the biopsy site after the application of a lidocainemight interfere with subsequent imaging and the targeting of an underlyingnodule for FNAB, especially in a patient with a superficial nodule or nodulesize less than 1 cm. This might decrease the diagnostic yield of FNAB, whichis not a problem for EMLA application.
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(1.) Gharib H, Papini E, Valcavi R, Baskin HJ, Crescenzi A,Dottorini ME, Duick DS, Guglielmi R, Hamilton CR Jr, Zeiger MA, Zini M;AACE/AME Task Force on Thyroid Nodules. American Association of ClinicalEndocrinologists and Associazione Medici Endocrinologi medical guidelines forclinical practice for the diagnosis and management of thyroid nodules. EndocrPract 2006; 12: 63-102.
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