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Nadda R, Repaka R, Mallik N, Sahani AK. A prospective survey on trephine biopsy of bone and bone marrow: an experience with 274 Indian patients' biopsies. Eur J Med Res 2023; 28:193. [PMID: 37353842 DOI: 10.1186/s40001-023-01167-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/11/2023] [Indexed: 06/25/2023] Open
Abstract
Trephine bone marrow biopsy is an effective technique for diagnosing hematological malignancies in patients of different ages. During trephine biopsy, bone marrow cores are obtained for detailed morphological evaluation to look for any abnormality and arrive at a diagnosis. The primary goal of this work is to perform a survey on Indian patients of various ages for the trephine bone marrow biopsy process. In the present study, data related to 274 trephine biopsy samples from 300 patients were acquired at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India. Pain was found to be the sole major procedure-related complication, and patients reported no/less pain in 41 BMB (14.96%) patients, moderate pain in 82 (29.92%) cases, and unbearable pain in 151 (55.1%) BMB cases. In addition, the patients were evaluated by the authors and hematologist as non-anxious for the procedure in 34 (12.4%), anxious in 92 (33.57%), and very/highly anxious in 148 (56%) cases. The bone texture of the patients significantly affected the needle bending, number of repetitions required, and size of the bone marrow sample. This demonstrates the need for improvement in the biopsy procedure. To this end, a survey was conducted to assess the numerous difficulties and diagnostic outcomes throughout the trephine biopsy process.
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Affiliation(s)
- Rahul Nadda
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India.
| | - Ramjee Repaka
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
| | - Nabhajit Mallik
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Kumar Sahani
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India
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Mihailescu SD, Jaselme P, Fontoura ML, Feddag-Hannachi L, Veresezan EL, Drieux F, Camus V, Bouclet F, Tilly H, Cardinaël N, Jardin F. Comparison of bone marrow trephine sample quality between a drill-powered system and a manual needle system. Ann Diagn Pathol 2022; 59:151952. [DOI: 10.1016/j.anndiagpath.2022.151952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
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Jeyaraman M, Bingi SK, Muthu S, Jeyaraman N, Packkyarathinam RP, Ranjan R, Sharma S, Jha SK, Khanna M, Rajendran SNS, Rajendran RL, Gangadaran P. Impact of the Process Variables on the Yield of Mesenchymal Stromal Cells from Bone Marrow Aspirate Concentrate. Bioengineering (Basel) 2022; 9:bioengineering9020057. [PMID: 35200410 PMCID: PMC8869489 DOI: 10.3390/bioengineering9020057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
Human bone marrow (BM) has been highlighted as a promising source of mesenchymal stromal cells (MSCs) containing various growth factors and cytokines that can be potentially utilized in regenerative procedures involving cartilage and bone. However, the proportion of MSCs in the nucleated cell population of BM is only around 0.001% to 0.01% thereby making the harvesting and processing technique crucial for obtaining optimal results upon its use in various regenerative processes. Although several studies in the literature have given encouraging results on the utility of BM aspiration concentrate (BMAC) in various regenerative procedures, there is a lack of consensus concerning the harvesting variables such as choice of anesthetic agent to be used, site of harvest, size of the syringe to be used, anticoagulant of choice, and processing variables such as centrifugation time, and speed. In this review article, we aim to discuss the variables in the harvesting and processing technique of BMAC and their impact on the yield of MSCs in the final concentrate obtained from them.
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Affiliation(s)
- Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai 600095, India;
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
| | - Shiva Kumar Bingi
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Fellow in Orthopaedic Rheumatology, Dr. RML National Law University, Lucknow 226010, India
| | - Sathish Muthu
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Department of Orthopaedics, Government Medical College and Hospital, Dindigul 624304, India
- Correspondence: (S.M.); (N.J.); (P.G.)
| | - Naveen Jeyaraman
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Fellow in Orthopaedic Rheumatology, Dr. RML National Law University, Lucknow 226010, India
- Fellow in Joint Replacement, Department of Orthopaedics, Atlas Hospitals, Tiruchirappalli 620002, India
- Correspondence: (S.M.); (N.J.); (P.G.)
| | | | - Rajni Ranjan
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida 201310, India;
| | - Shilpa Sharma
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India;
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201310, India;
| | - Manish Khanna
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, India; (S.K.B.); (M.K.)
- Department of Orthopaedics, Prasad Institute of Medical Sciences, Lucknow 226401, India
| | - Sree Naga Sowndary Rajendran
- Department of Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry 605102, India;
| | - Ramya Lakshmi Rajendran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
| | - Prakash Gangadaran
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea;
- BK21 FOUR KNU Convergence Educational Program of Biomedical Sciences for Creative Future Talents, Department of Biomedical Sciences, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: (S.M.); (N.J.); (P.G.)
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Gendron N, Zia Chahabi S, Poenou G, Rivet N, Belleville-Rolland T, Lemaire P, Escuret A, Ciaudo M, Curis E, Gaussem P, Siguret V, Darnige L. Pain assessment and factors influencing pain during bone marrow aspiration: A prospective study. PLoS One 2019; 14:e0221534. [PMID: 31465426 PMCID: PMC6715342 DOI: 10.1371/journal.pone.0221534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022] Open
Abstract
Although bone marrow aspiration (BMA) is still considered a painful procedure, pain level remains poorly documented. We therefore conducted a prospective study intended to evaluate pain level in adult patients undergoing BMA at the sternal or iliac crest site to identify factors associated with pain. We enrolled a total of 448 patients who underwent 461 BMA and asked those patients to score their pain intensity after BMA using numerical pain rating scale (NPRS). The following factors: level of anxiety, quality of the information given to the patient, operator’s experience, and bone texture were recorded using a standardized questionnaire. The median NPRS score was 3.5 (IQR [2.0; 5.0]) the sternal site (n = 405) was associated with an increased median NPRS score (3.5 [2.0; 5.0]) compared to the iliac crest (n = 56, 2.5 [1.0; 4.0]; p<0.0001). For those patients who underwent sternal BMA, the median NPRS score was significantly lower when using lidocaine infiltration (p = 0.0159) as compared with no anesthetic use. Additionally there was no significant effect of anesthetic cream found. After multivariate analysis, the model of NPRS score at the sternal site included patient anxiety (p<0.0001) and the use of lidocaine infiltration (0.0378). This study underlines the usefulness of a comprehensive management including pain relief and efforts to reduce anxiety including appropriate information given to the patient during BMA.
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Affiliation(s)
- Nicolas Gendron
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Sara Zia Chahabi
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- AP-HP, Hôpital Lariboisière, Paris, France
| | - Géraldine Poenou
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
| | - Nadia Rivet
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Tiphaine Belleville-Rolland
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Pierre Lemaire
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
| | - Antoine Escuret
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
| | - Michèle Ciaudo
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
| | - Emmanuel Curis
- Université de Paris, Paris, France
- Laboratoire de Biomathématiques, plateau iB, Faculté de Pharmacie de Paris, Université Paris Descartes, Paris, France
- Service de Biostatistiques et Informatique Médicale, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Pascale Gaussem
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
| | - Virginie Siguret
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
- AP-HP, Hôpital Lariboisière, Paris, France
| | - Luc Darnige
- AP-HP, Hôpital Européen Georges Pompidou, Service d’Hématologie Biologique, Paris, France
- Université de Paris, Paris, France
- INSERM UMR-S1140, Paris, France
- * E-mail:
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Kuivalainen AM, Ebeling F, Poikonen E, Rosenberg PH. Nitrous oxide analgesia for bone marrow aspiration and biopsy - A randomized, controlled and patient blinded study. Scand J Pain 2015; 7:28-34. [PMID: 29911602 DOI: 10.1016/j.sjpain.2015.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Abstract
Background and aims Bone marrow aspiration and/or biopsy (BMAB), performed under local anaesthesia in adults, is a common and often painful procedure. Anxiety is known to intensify pain during the procedure. Nitrous oxide (N2O), known for its sedative and analgesic benefit in various short medical procedures and labour pain, could be advantageous also for pain relief during bone marrow examination. N2O acts rapidly and is eliminated in a couple of minutes once the inhalation is stopped, and occasional side effects (e.g. dizziness and nausea) are mild. The aim of this study was to compare the analgesic effects of inhaled 50% mixture of nitrous oxide and oxygen to 50% oxygen during bone marrow examination. Methods In this randomized, controlled, patient and observer blinded study patients received either 50% mixture of nitrous oxide and oxygen or 50% mixture of oxygen in air during bone marrow examination, in addition to local analgesia. Both patient groups comprised 35 adult patients. Pre-procedural anxiety and procedural pain were rated on the Numeral Rating Scale (NRS 0‒10). Cognitive function was measured before and 30 min after the procedure. Possible side effects were recorded. A telephone interview was performed 24 h later. Results There were no statistically significant differences in pain scores of the procedural steps (median NRS ranging 3.0‒4.0) between the study groups. High pain scores of 8‒10 comprised 0% vs. 8.6% of the scores during infiltration, 2.9% vs. 5.7% during puncture, 11.4% vs. 14.3% during aspiration and 2.9% vs. 2.9% during biopsy in N2O and 50% O2 groups, respectively (NS). Pre-procedural anxiety (median NRS 3.5 in both groups), measured in the outpatient clinic just prior to procedure, correlated with pain intensity during bone marrow aspiration (P = 0.045). There were no significant differences between side effects. During the BMAB four patients (3 in N2O group, 1 in 50% O2 group) reported dizziness and one patient in the N2O group reported nausea. Gas inhalation did not affect the cognitive function of the participants. In both groups the majority (>80%) of the patients was satisfied with the inhalation technique. During the 24 h interview, most of the participants were pain free and they did not report any serious adverse effects. Conclusions In spite of similar moderate to strong procedural pain in both groups and no benefit of N2O, most patients were satisfied with the inhalational techniques. We assume that the bedside presence of an anaesthesiologist and the distraction caused by the inhalational arrangements introduced positive context-sensitive therapeutic effect independent of the gas used. Pre-procedural anxiety predicted pain associated with bone marrow aspiration. Implications Inhaled 50% nitrous oxide was not an effective analgesic during bone marrow examination in our unselected outpatient population. Further studies should concentrate on its use with patients predicted to be at increased risk of suffering intense pain during the procedure, such as very anxious patients or those who have a painful history of previous bone marrow examinations.
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Affiliation(s)
- Anna-Maria Kuivalainen
- Department of Anaesthesiology and Intensive Care Medicine, University of Helsinki, PO Box 20, FIN-00014 Helsinki, Finland
| | - Freja Ebeling
- Cancer Center, Division of Haematology, Helsinki University Central Hospital, PO Box 372, FIN-00029 HUS Helsinki, Finland
| | - Eira Poikonen
- Cancer Center, Division of Haematology, Helsinki University Central Hospital, PO Box 372, FIN-00029 HUS Helsinki, Finland
| | - Per H Rosenberg
- Department of Anaesthesiology and Intensive Care Medicine, University of Helsinki, PO Box 20, FIN-00014 Helsinki, Finland
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McKeown A, Gewandter JS, McDermott MP, Pawlowski JR, Poli JJ, Rothstein D, Farrar JT, Gilron I, Katz NP, Lin AH, Rappaport BA, Rowbotham MC, Turk DC, Dworkin RH, Smith SM. Reporting of sample size calculations in analgesic clinical trials: ACTTION systematic review. THE JOURNAL OF PAIN 2014; 16:199-206.e1-7. [PMID: 25481494 DOI: 10.1016/j.jpain.2014.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Sample size calculations determine the number of participants required to have sufficiently high power to detect a given treatment effect. In this review, we examined the reporting quality of sample size calculations in 172 publications of double-blind randomized controlled trials of noninvasive pharmacologic or interventional (ie, invasive) pain treatments published in European Journal of Pain, Journal of Pain, and Pain from January 2006 through June 2013. Sixty-five percent of publications reported a sample size calculation but only 38% provided all elements required to replicate the calculated sample size. In publications reporting at least 1 element, 54% provided a justification for the treatment effect used to calculate sample size, and 24% of studies with continuous outcome variables justified the variability estimate. Publications of clinical pain condition trials reported a sample size calculation more frequently than experimental pain model trials (77% vs 33%, P < .001) but did not differ in the frequency of reporting all required elements. No significant differences in reporting of any or all elements were detected between publications of trials with industry and nonindustry sponsorship. Twenty-eight percent included a discrepancy between the reported number of planned and randomized participants. This study suggests that sample size calculation reporting in analgesic trial publications is usually incomplete. Investigators should provide detailed accounts of sample size calculations in publications of clinical trials of pain treatments, which is necessary for reporting transparency and communication of pre-trial design decisions. PERSPECTIVE In this systematic review of analgesic clinical trials, sample size calculations and the required elements (eg, treatment effect to be detected; power level) were incompletely reported. A lack of transparency regarding sample size calculations may raise questions about the appropriateness of the calculated sample size.
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Affiliation(s)
- Andrew McKeown
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Joseph R Pawlowski
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Joseph J Poli
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Daniel Rothstein
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - John T Farrar
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ian Gilron
- Queen's University, Kingston, Ontario, Canada
| | - Nathaniel P Katz
- Analgesic Solutions, Natick, Massachusetts; Department of Anesthesiology, Tufts University, Boston, Massachusetts
| | - Allison H Lin
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | - Bob A Rappaport
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, Maryland
| | | | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Center for Human Experimental Therapeutics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Shannon M Smith
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
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Ripamonti CI, Bossi P, Santini D, Fallon M. Pain related to cancer treatments and diagnostic procedures: a no man's land? Ann Oncol 2014; 25:1097-106. [PMID: 24625453 DOI: 10.1093/annonc/mdu011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND While guidelines are available for the management of cancer-related pain, little attention is given to the assessment and treatment of pain caused by treatments and diagnostic procedures in cancer patients. METHODS We evaluated the literature on pain related to cancer treatment and diagnostic procedures within a critical analysis. RESULTS The data available are sparse, suggesting that little attention has been directed at this important aspect of oncology. This points to potentially suboptimal patient management. CONCLUSIONS Appropriate studies are necessary in order to understand the incidence and appropriate management of pain, both during and/or after oncological treatments and diagnostic procedures. At the same time, Health Care Professionals should have heightened awareness of the causes and treatment of pain with the aim of anticipating and managing pain most appropriately for each individual patient. This is clearly an important component of holistic patient care before, during, and after oncological treatment.
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Affiliation(s)
- C I Ripamonti
- Supportive Care in Cancer Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - P Bossi
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan
| | - D Santini
- Medical Oncology Unit, Università Campus Bio-Medico, Rome, Italy
| | - M Fallon
- St Columba's Hospice Chair of Palliative Medicine, IGMM, University of Edinburgh, Edinburgh, UK
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8
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Kuivalainen AM, Ebeling F, Rosenberg P. Warmed and buffered lidocaine for pain relief during bone marrow aspiration and biopsy. A randomized and controlled trial. Scand J Pain 2014; 5:43-47. [PMID: 29913658 DOI: 10.1016/j.sjpain.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/31/2013] [Indexed: 10/25/2022]
Abstract
Background and purpose Local infiltration anaesthesia is frequently painful due to low pH of the used anaesthetics, such as lidocaine. Usually pH of the solution is near 4.0, which causes tissue irritation and excitation of the pain mediating nerve endings. Warming and buffering the local anaesthetic solution have been shown to reduce the patient's experience of pain and unpleasantness during infiltration. Buffering reduces the dissociation of the local anaesthetic molecule and may enhance the anaesthetic's entrance into nerve cells. In this randomized placebo-controlled trial warmed and buffered lidocaine with adrenaline was compared to room temperature unbuffered lidocaine with adrenaline infiltrated before bone marrow aspiration and/or biopsy (BMAB). The aim was to find out to what extent warming and buffering would diminish pain during infiltration and whether this would be reflected in less pain also during subsequent steps of the BMAB procedure. Methods One hundred patients scheduled to undergo BMAB were interviewed regarding subjective experiences from previous medical procedures, current chronic and temporary medications, and their present state of anxiety before the BMAB procedure. They received local anaesthetic infiltration of lidocaine prior to BMAB. The solution used was either warmed lidocaine 20 mg/ml with adrenaline buffered with sodium bicarbonate 75 mg/ml (warmed and buffered group, 50 patients, pH approximately 7.3, 32°C) or unbuffered lidocaine 20 mg/ml with adrenaline mixed with NaCl 0.9% solution (control group, 50 patients, pH approximately 3.7, room temperature). The lidocaine concentration was similar in both groups. The bone marrow sampling needle was inserted 2 min after local anaesthetic infiltration. The grade of preprocedural anxiety, and pain sensations during the BMAB, both rated on NRS (numeral rating scale, 0-10) were compared between the groups. Results In comparison with the use of an unbuffered solution at room temperature warmed and buffered lidocaine with adrenaline caused less pain during infiltration (median NRS 4.0 vs. 2.0, P < 0.002) but it did not make performing the other phases of BMAB any less painful. As expected, painful experiences from previous medical, other than BMAB, or dental procedures and anxiety were associated with local anaesthetic infiltration pain during BMAB. Patients' own pain or anxiolytic medication did not lessen pain during BMAB. Conclusions By warming and buffering the lidocaine solution containing adrenaline it is possible to make the pain during infiltration less intense. Unfortunately, such benefit was not detected during the following steps of BMAB, initiated 2 min later. Preprocedural anxiety made procedural pain more intense including that of the local anaesthetic infiltration. Implications Warming and buffering the local anaesthetic prior to its administration is an effective and simple way of diminishing pain during infiltration. This benefit seems to be underutilized in the BMAB procedure. However, warming and buffering are not sufficient enough to diminish pain during bone marrow sampling and thus additional pain alleviating methods should be used, particularly in patients showing preprocedural anxiety.
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Affiliation(s)
- Anna-Maria Kuivalainen
- Department of Anaesthesiology and Intensive Care Medicine, University of Helsinki, PO Box 20, FIN-00014 Helsinki, Finland
| | - Freja Ebeling
- Department of Haematology, Helsinki University Central Hospital, PO Box 372, FIN-00029 HUS, Finland
| | - Per Rosenberg
- Department of Anaesthesiology and Intensive Care Medicine, University of Helsinki, PO Box 20, FIN-00014 Helsinki, Finland
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10
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Kuivalainen AM, Ebeling F, Rosenberg P. Pre-medication with sublingual fentanyl did not relieve pain associated with bone marrow aspiration and biopsy: A randomized feasibility trial. Eur J Pain 2013; 17:1357-64. [DOI: 10.1002/j.1532-2149.2013.00303.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 11/08/2022]
Affiliation(s)
- A.-M. Kuivalainen
- Department of Anaesthesiology and Intensive Care Medicine; University of Helsinki; Finland
| | - F. Ebeling
- Department of Haematology; Helsinki University Hospital; Finland
| | - P.H. Rosenberg
- Department of Anaesthesiology and Intensive Care Medicine; University of Helsinki; Finland
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11
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Hjortholm N, Jaddini E, Hałaburda K, Snarski E. Strategies of pain reduction during the bone marrow biopsy. Ann Hematol 2012; 92:145-9. [PMID: 23224244 PMCID: PMC3542425 DOI: 10.1007/s00277-012-1641-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/21/2012] [Indexed: 11/13/2022]
Abstract
Examination of the bone marrow biopsy and aspirate allows diagnosis and assessment of various conditions such as primary hematologic and metastatic neoplasms, as well as nonmalignant disorders. Despite being performed for many years, according to many different protocols, the procedure still remains painful for the majority of patients. This paper summarizes the current knowledge of pain reduction measures in the bone marrow biopsy and aspiration.
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Affiliation(s)
- Nikolaj Hjortholm
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
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12
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Lord S, Bhuller K. Managing pain and anxiety in adult bone marrow examinations: combining pharmacological and psychological approaches. J Pain Symptom Manage 2012; 44:757-62. [PMID: 22771127 DOI: 10.1016/j.jpainsymman.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 10/31/2011] [Accepted: 11/06/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Sharon Lord
- Kettering General Hospital NHS Foundation Trust, Kettering, United Kingdom.
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13
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Bajwa SJS, Jindal R. Use of Articaine in loco-regional anesthesia for day care surgical procedures. J Anaesthesiol Clin Pharmacol 2012; 28:444-50. [PMID: 23225921 PMCID: PMC3511938 DOI: 10.4103/0970-9185.101898] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The popularity of day case surgical procedures has increased immensely over the last few years. Though various techniques are available for carrying out day-case anesthesia, preference for a technique depends upon the type of procedure, patient profile, associated co-morbidities, available infrastructure and back-up facilities, monitoring devices and comfort of the attending anesthesiologist with the technique. Day-case spinal anesthesia for ambulatory surgery has gained a wider acceptance and numerous drugs are available for use in loco-regional anesthesia. Articaine is one such amide local anesthetic drug which is increasingly being used in day care surgeries. Properties of articaine such as faster onset, shorter elimination time and rapid recovery from sensory and motor blockade make it a very useful agent in local and regional anesthesia for day care surgical procedures. This article aims to review these properties of articaine so as to evaluate how useful articaine can be for ambulatory surgical procedures.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Ravi Jindal
- Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
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14
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Anxiety and pain during bone marrow aspiration and biopsy. Scand J Pain 2012; 3:92-96. [DOI: 10.1016/j.sjpain.2011.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/07/2011] [Indexed: 11/21/2022]
Abstract
Abstract
Background
Previously we found that pre-procedural nervousness and tension (translated into English as “anxiety”), assessed on a non-validated five-point scale, correlated with pain intensity of the various stages of bone marrow aspiration and biopsy (BMAB). The fewer the previous BMAB procedures the stronger the pain from a repeated procedure. The primary purpose of the present observational study is to evaluate the state of anxiety just before BMAB and to find out whether it affects the pain experiences during the various stages of the BMAB procedure. We also examined whether first-timers differ from patients with previous BMAB experience in the degree of anxiety and intensity of BMAB procedural pain.
Methods
A total of 166 adult outpatients undergoing the BMAB from the Helsinki University Hospital were enrolled, 48 of them being first-timers. The level of anxiety was measured with State-Trait Anxiety Inventory (STAI) and the pain experiences associated with the various stages of the procedure were evaluated on the NRS-scale (Numeral Rating Scale 0-10) and using the Finnish pain vocabulary. BMAB was planned to be performed under lidocaine infiltration anaesthesia but, on request, patients were allowed to receive premedication with diazepam orally or alfentanil i.m. If, in spite of supplemental local anaesthetic the patient still felt pain from the sampling needle tip, i.m. alfentanil was administered.
Results
There was a clear association between anxiety and pain during all stages of the procedure, except during biopsy. The NRS scores varied from 0 to 10 in all the various stages of BMAB. The first-timers did not differ from the more experienced patients with regard to pain experiences; only the pain felt during the local anaesthetic infiltration was milder (P = 0.007) in first-timers than in the others. Procedural pain in those who were given analgesic or sedative premedication was similar (P < 0.05) to that in the non-premedicated patients. The words characterizing the pain of the various stages belonged to a major extent (76-90%) to the sensory class of words.
Conclusion
Pre-procedural anxiety had a major impact on the pain ratings. The first-timers and patients with previous experience of BMAB had a similar degree of pre-procedural anxiety, as well as of the intensity of procedural pain, except that infiltration of local anaesthetic was less painful in the first-timers.
Implications
Identification of anxious (fearful) patients prior to BMAB, and premedicating them individually may improve satisfaction in both patient and caregiver.
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Guillot M, Rialland P, Nadeau MÈ, del Castillo J, Gauvin D, Troncy E. Pain Induced by a Minor Medical Procedure (Bone Marrow Aspiration) in Dogs: Comparison of Pain Scales in a Pilot Study. J Vet Intern Med 2011; 25:1050-6. [DOI: 10.1111/j.1939-1676.2011.00786.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 06/03/2011] [Accepted: 07/14/2011] [Indexed: 11/28/2022] Open
Affiliation(s)
- M. Guillot
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ); Department of Veterinary Biomedical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - P. Rialland
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ); Department of Veterinary Biomedical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - M.-È. Nadeau
- Companion Animal Research Group; Department of Clinical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - J.R.E. del Castillo
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ); Department of Veterinary Biomedical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - D. Gauvin
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ); Department of Veterinary Biomedical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
| | - E. Troncy
- Groupe de Recherche en Pharmacologie Animale du Québec (GREPAQ); Department of Veterinary Biomedical Sciences; Faculté de Médecine Vétérinaire; Université de Montréal; Saint-Hyacinthe; Québec; Canada
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