title: Oral administration of analgesia and anxiolysis for pain associated with bone marrow biopsy.
abstract: OBJECTIVE
  Medical literature provides only scarce data about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB), and little is known about the factors that can modify the perception of pain. In this study, we evaluated the effectiveness of a combination of analgesia and anxiolysis in reducing the pain score of patients undergoing BMAB.
  
  
  METHODS
  Eighty-four consecutive adult patients underwent BMAB after local anesthesia with 5 mL of lidocaine hydrochloride 1% aqueous solution in the left posterior superior iliac crest. Analgesia was obtained with acetaminophen 650 mg and oxycodone 10 mg, and anxiolysis was obtained with lorazepam 2 mg, all drugs given once orally 30 min before the procedure. We assessed the pain level with the Wong-Baker Faces Pain Rating Scale, which distinguishes six levels of pain, from 0 to 5.
  
  
  RESULTS
  The 34 patients who received an oral administration of analgesia and anxiolysis reported pain at lower levels, i.e., in the range of 0-2, more frequently than the 50 patients who underwent BMAB without analgesia/anxiolysis (78% vs 64%, respectively). Among several predictors analyzed using a multivariate regression model, three were found to be associated with decreased pain level: the use of analgesia/anxiolysis, male sex, and increase in age (all with p values <0.05). Length of the extracted bone specimen, body mass index, and need of a spinal needle for anesthesia in obese patients did not predict for pain level.
  
  
  CONCLUSIONS
  An oral administration of prophylactic regimen of analgesia and anxiolysis, at the above-mentioned doses, produced a statistically significant reduction of the perception of pain in patients undergoing BMAB, but its effect did not seem to provide a major and clinically significant reduction of pain level.
authors.affiliation: Penn State Milton S. Hershey Cancer Institute, 500 University Dr, Hershey, PA 17033, USA. gtalamo@hmc.psu.edu
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Talamo
authors.forename: Jason
authors.initials: J
authors.lastname: Liao
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bayerl
authors.forename: David F
authors.initials: DF
authors.lastname: Claxton
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zangari
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage*; D000772:Anesthesia, Local; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D001707:Biopsy, Needle / Q000009:adverse effects*; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement
chemical_list: D000700:Analgesics; D014151:Anti-Anxiety Agents; D000082:Acetaminophen; D010098:Oxycodone; D008140:Lorazepam