title: Perceived levels of pain associated with bone marrow aspirates and biopsies.
abstract: BACKGROUND
  Little is known about the degree of pain experienced by patients undergoing a bone marrow aspiration and biopsy (BMAB).
  
  
  OBJECTIVE
  To evaluate the effectiveness of several strategies aimed at reducing the pain score.
  
  
  METHODS
  We conducted a retrospective analysis of 258 consecutive adult patients who underwent BMAB via 6 different approaches, the first 5 of which were performed by one physician. Group A received local anesthesia with 1% lidocaine hydrochloride (5 mL) and a 5-minute wait time before the procedure; group B received local anesthesia with a double dose (10 mL) of lidocaine; group C received 5 mL of local anesthesia with a 10-minute wait; group D received 5 mL of local anesthesia plus a topical spray with ethyl chloride; group E received oral analgesia and anxiolysis 30 minutes before the procedure in addition to the group A dosage of lidocaine; and group F received the same anesthesia as did group A, but the BMAD was performed by a less experienced practitioner.
  
  
  RESULTS
  On a 0 to 10 scale, the mean pain level among the 258 patients was 3.2 (standard deviation = 2.6). Rate of complications was low (<1%). Several strategies failed to improve the pain level, including the administration of a double dose of local anesthesia, waiting longer for the anesthesia effect, and the additional use of a topical anesthetic spray or oral analgesia and anxiolysis. Pain levels were not increased when the procedure was done by a less experienced practitioner. Younger age and female gender were associated with higher pain levels.
  
  
  CONCLUSIONS
  Given that the average level of perceived pain during BMAB is low to moderate (approximately 3 on a 0-10 scale), the routine use of conscious sedation for this procedure may not be indicated. Several strategies aimed at reducing the pain level, including doubling the dose of anesthesia and using an oral prophylactic regimen of analgesia and anxiolysis, failed to improve pain scores.
authors.affiliation: Penn State Hershey Cancer Institute, 500 University Drive, 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: Jamal
authors.initials: J
authors.lastname: Joudeh
authors.forename: Nicholas E
authors.initials: NE
authors.lastname: Lamparella
authors.forename: Hoang
authors.initials: H
authors.lastname: Dinh
authors.forename: Jozef
authors.initials: J
authors.lastname: Malysz
authors.forename: W Christopher
authors.initials: WC
authors.lastname: Ehmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D001706:Biopsy; D001853:Bone Marrow / Q000473:pathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058748:Pain Perception; D012189:Retrospective Studies