Bone marrow harvesting using local anaesthesia and PCA-alfentanil: a feasible alternative to general or regional anaesthesia.
We examined the feasibility of combined use of local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-alfentanil) for bone marrow harvesting (BMH) in 16 consecutive in-patient donors (nine allogeneic and seven autologous). A loading dose of alfentanil 15 micrograms/kg was delivered at the time of skin preparation followed by a background infusion of alfentanil 0.05 microgram/kg/min. On -demand bolus doses of alfentanil were 4 micrograms/kg with lockout intervals of 3 min. Local anaesthesia was achieved using 1% lignocaine (up to 7 mg/kg) with 1:200,000 adrenaline. All donors were mildly sedated during BMH, tolerated the procedure well, and experienced no cardiovascular or respiratory complications. Post-operative nausea and vomiting were the only side-effects. All donors indicated that the combined use of LA with PCA-alfentanil was acceptable for BMH. Our preliminary results suggest that although optimal PCA settings have yet to be determined, this technique may be a feasible and effective alternative for BMH in situations where general or regional anaesthesia is undesirable.
Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Republic of Singapore.
K M
KM
Sim
S K
SK
Boey
L T
LT
Wong
D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage* / Q000009:adverse effects; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D016026:Bone Marrow Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014839:Vomiting / Q000209:etiology
D000701:Analgesics, Opioid; D015760:Alfentanil