Use Epinephrine with lidocaine for FNA?
QUESTION-It's common practice to use plain lidocaine with fine needle aspiration of thyroid nodules. I am wondering if any reason against using  Epinephrine with the Lidocaine for fine needle aspiration  ? Thank you, Rami Mortada, MD, ECNU, FACE ,Endocrine Center of Kansas.

RESPONSE-In our center we perform over 2000 thyroid FNA each year and we never use local anesthesia, similarly to most european centers. The pain of a 25 needle is perfectly tolerable (if the manuver is gently performed) and is probably lower than that induced by the injection of xylocaine. Anyway, there is no advantage in the association of epinefrine to the anesthetic. In the past it was due to the need of inducing a vasoconstriction and so to decrease the risk of bleeding and the permanence of the anesthetic in the tissue to be biopsied. For thyroid FNA this risk is negligible while epinefrine may induce cardiovascular side effects.  So, on the basis of a large clinical practice, I would suggest not to use anesthetics or to use them without the addition of epinephrine.  Enrico Papini, MD   Italy