Improving the patient's experience of a bone marrow biopsy - an RCT.
OBJECTIVE
To compare nitrous oxide 50%/oxygen 50% (N(2)O/O(2)- entonox) plus local anaesthetic (LA) with placebo (oxygen) plus LA in the management of pain experienced by patients undergoing a bone marrow biopsy.


BACKGROUND
Bone marrow biopsies are a common procedure for many haematological conditions. Despite the use of a LA, pain during the procedure has frequently been reported by patients. Previous research in pain management of other invasive diagnostic procedures (e.g. sigmoidoscopy) has reported N(2)O/O(2) as an effective alternative to LA.


METHODS
Double-blind randomized controlled trial.


METHODS
Forty-eight patients requiring a bone marrow biopsy were randomized to receive either N(2)O/O(2) or oxygen in addition to their LA. Participants were asked to complete a pain score and comment on their experience of the procedure.


RESULTS
Although the overall pain scores were moderate, there was a wide range of scores. N(2)O/O(2) resulted in significantly less pain for men, but not for women. All patients who had had previous biopsies reported significantly more pain, regardless of the gas used. There were no significant adverse effects in either group.


CONCLUSIONS
N(2)O/O(2) is a safe, effective, easy-to-use analgesic which merits further investigation in potentially painful diagnostic (and other) interventions. Relevance to clinical practice. Relief of pain is an important issue for nurses. Appropriate assessment of pain experience is a key issue. Nurses should reflect on their own area of practice and identify what is known about the effectiveness of pain management from their patient's perspective. Individual differences may be important, and careful instruction regarding appropriate administration of analgesic agents, such as N(2)O/O(2) may enhance their effectiveness.
Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, UK. helen.johnson@bradfordhospitals.nhs.uk
Helen
H
Johnson
Debbie
D
Burke
Caroline
C
Plews
Rob
R
Newell
Liakat
L
Parapia
D000704:Analysis of Variance; D018685:Anesthetics, Inhalation / Q000627:therapeutic use*; D001856:Bone Marrow Examination / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*
D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide