Reduced Pain Scores during Indocyanine Green Lymphography by using a Different Preparation Formula
Article Sidebar
Main Article Content
Abstract
Purpose: The purpose of this study was to investigate whether a different indocyanine green lymphography formula can reduce the severe pain encountered during this investigation.
Methods: Indocyanine green ICG lymphography frequently induces severe and intolerable pain in patients. It is very important to develop a relatively painless lymphography method. This helps reduce patients’ apprehension during examination. Our center conducted randomized control groups of 60 patients with limb lymphedema. Cases were divided into experimental and control groups. Patients in the experimental group were injected with indocyanine green solution containing 5% glucose, while patients in the control group were injected with indocyanine green solution with sterile water.
VAS scores were recorded pre-injection, during, and at 10, 20, and 30 minutes post-injection. We recorded possible side effects, e.g. skin redness, itching, subcutaneous bleeding, bruising, severe allergic reactions, and other complications within 24 and 48 hours after imaging, and analyzed the pain score data.
Results: The average pain score of the experimental group was 0-3 points, while the control group was 6-8 points. Disease staging was accurately assessed based on imaging results . No other serious complications occurred.
Conclusion: Pain can be significantly reduced by the new modality. This method does not affect lymphography results and imaging quality, and there are no obvious serious complications.
Article Details
Copyright (c) 2025 Wen J, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Berk BO, Sonia KP, Graham SS. Artificial Intelligence-Based Indocyanine Green Lymphography Pattern Classification for Management of Lymphatic Disease. Plast Reconstr Surg Glob Open. 2024;12(8):e6132. Available from: https://doi.org/10.1097/gox.0000000000006132
Yamamoto T, Yamamoto N, Doi K, Yoshimatsu H, Todokoro T, Ogata F, et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: A novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011;128:941–947. Available from: https://doi.org/10.1097/prs.0b013e3182268cd9
Robert AS. Progress in lymphedema. Med Oncol. 2024;41(11):261. Available from: https://link.springer.com/article/10.1007/s12032-024-02509-z
Mads GJ, Anne PH, Anette RM, Steffanie C, Jens AS, et al. Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema. Sci Rep. 2021;11(1):21103. Available from: https://doi.org/10.1038/s41598-021-00396-2
Unno N, Nishiyama M, Suzuki M, Nishiyama M, Tanaka H, Yamamoto N, Sagara D, et al. A novel method of measuring human lymphatic pumping using indocyanine green fluorescence lymphography. J Vasc Surg. 2010;52:946–952. Available from: https://doi.org/10.1016/j.jvs.2010.04.067
Cormier JN, Rourke L, Crosby M, Chang D, Armer J. The surgical treatment of lymphedema: A systematic review of the contemporary literature (2004–2010). Ann Surg Oncol. 2012;19:642–651. Available from: https://doi.org/10.1245/s10434-011-2017-4
Elizabeth T, Sarah T, Jaime P, Granoff M, Yamamoto T, Singhal D. Improving the Patient Experience with Indocyanine Green Lymphography. Plast Reconstr Surg. 2022;150(5):1121e-1123e. Available from: https://doi.org/10.1097/prs.0000000000009594
Tarek SS, Rehab E. The Visual Analogue Scale Versus Numerical Rating Scale in Measuring Pain Severity and Predicting Disability in Low Back Pain. J Clin Rheumatol. 2021;27(7):282-285. Available from: https://doi.org/10.1097/rhu.0000000000001320
Sara CC, Andrew JJ, Daniella K, Karagoz H. Lymphedema: Current Strategies for Diagnostics and Management. Ann Plast Surg. 2024;93(6S Suppl 3):S167-S171. Available from: https://doi.org/10.1097/sap.0000000000004044
Kim K, Kim I-J, Pak K, Kim SJ, Choi SJ, Park H, et al. The feasibility of quantitative parameters of lymphoscintigraphy without significant dermal backflow for the evaluation of lymphedema in post-operative patients with breast cancer. Eur J Nucl Med Mol Imaging. 2020;47:1094–1102. Available from: https://doi.org/10.1007/s00259-019-04576-1
Yamamoto T, Mitsunaga N, Kentaro D, Oshima A, Ogata F, Mihara M, et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011;127(5):1979-1986. Available from: https://doi.org/10.1097/prs.0b013e31820cf5df
Yamamoto T, Yamamoto N, Kentaro D, Oshima A, Yoshimatsu H, Todokoro T, et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011;128(4):941-947. Available from: https://doi.org/10.1097/prs.0b013e3182268cd9
Yamamoto T, Mitsunaga N, Yoshimatsu H, Yamamoto N, Oka A, Seki Y, et al. Indocyanine green velocity: lymph transportation capacity deterioration with progression of lymphedema. Ann Plast Surg. 2013;71(5):591-4. Available from: https://doi.org/10.1097/sap.0b013e318255168a
Sarah T, Sophie R, Beate B-H, Fourneau I, Devoogdt N. Relation between characteristics of indocyanine green lymphography and development of breast cancer-related lymphedema. Lymphat Res Biol. 2024;22(5):248-254. Available from: https://doi.org/10.1089/lrb.2024.0009
Yamamoto T, Yamamoto N, Kageyama T, Sakai H, Fuse Y, Tsuihiji K. Technical pearls in lymphatic supermicrosurgery. Global Health Med. 2020;2(1):29–32. Available from: https://doi.org/10.35772/ghm.2019.01010
Ashok BC, Ritu B, Srikanth V, Yellambalase NA, Sreekumar D. A novel way of standardization of ICG lymphangiography reporting. Indian J Plast Surg. 2020;53(3):377-380. Available from: https://doi.org/10.1055/s-0040-1716436
Mads GJ, Anne PH, Anette RM, Steffanie C, Jens AS. Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema. Sci Rep. 2021;11(1):21103. Available from: https://doi.org/10.1038/s41598-021-00396-2
Wei FC, Evelyn SQ, Mindy JB, Little AS, Lensing JN. Exercise-enhanced ICG lymphography: A fast approach to diagnosis and staging of lymphedema. Int Micros J. 2021;8(1):2. Available from: https://scitemed.com/upload/5290/2999/scitemed.imj.2021.00140.pdf?t=1632
Jin AY, Myung JS, Joo HK. Indocyanine green lymphography and lymphoscintigraphy severity stage showed strong correlation in lower limb lymphedema. Lymphat Res Biol. 2021;19(1):80-85. Available from: https://doi.org/10.1089/lrb.2020.0043
Randheer S, Kadambari D, Srinivasan K, Bhuvaneswari V, Bhanumathy M, Salaja R. Comprehensive decongestive therapy in postmastectomy lymphedema: an Indian perspective. Indian J Cancer. 2011;48(4):397-402. Available from: https://doi.org/10.4103/0019-509x.92250
Eric T, Tim L, Mark AB, Phillips JL. Guidelines relevant to diagnosis, assessment, and management of lymphedema: A systematic review. Adv Wound Care (New Rochelle). 2023;12(1):15-27. Available from: https://doi.org/10.1089/wound.2021.0149
Mei RF, Sheila HR, Sophia HH, Stewart BR, Cormier JN, Armer JM. Psychosocial impact of lymphedema: A systematic review of literature from 2004–2011. Psychooncology. 2012;22(7):1466–1484. Available from: https://doi.org/10.1002/pon.3201