title: Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil.
abstract: Bone marrow harvesting (BMH) was performed on 40 consecutive allogeneic or autologous donors using EMLA (eutectic mixture of local anaesthetics), local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-A). The effect of alkalinizing the LA solution on reducing pain during LA infiltration in the presence of EMLA was also investigated. EMLA 10 g with occlusive dressing was applied to the harvest sites at least 60 min before BMH. The PCA device was programmed to deliver an intravenous loading dose of 15 microg/kg alfentanil, followed by a background alfentanil infusion of 0.05 microg/kg/min. Demand dose was 4 microg/kg and lockout time was 3 min. Donors were randomized to receive either alkalinized (n = 19) or non-alkalinized (n=21) LA solution (lignocaine 1% with 1:100000 adrenaline). While post-operative nausea and vomiting were the only side-effects, all donors in both groups reported satisfactory pain scores during LA infiltration and satisfactory overall intra-operative comfort scores. They completed BMH using either regimen successfully, found this technique acceptable and would recommend this form of anaesthesia to others. Alkalinizing the LA solution did not significantly improve the pain scores during LA infiltration in the presence of EMLA. In conclusion, BMH can be performed safely using EMLA, LA and PCA-A without major complications.
authors.affiliation: Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.
authors.forename: H N
authors.initials: HN
authors.lastname: Ng
authors.forename: K M
authors.initials: KM
authors.lastname: Sim
authors.forename: S K
authors.initials: SK
authors.lastname: Boey
mesh_terms: D000293:Adolescent; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage*; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016465:Bone Marrow Purging / Q000379:methods*; D016026:Bone Marrow Transplantation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008875:Middle Aged; D011318:Prilocaine / Q000008:administration & dosage*; D011446:Prospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D015760:Alfentanil; D008012:Lidocaine