title: Pre-medication with sublingual fentanyl did not relieve pain associated with bone marrow aspiration and biopsy: a randomized feasibility trial.
abstract: BACKGROUND
  Bone marrow aspiration and/or biopsy (BMAB) is often an unpleasant and painful procedure in spite of local anaesthetic infiltration. This randomized placebo-controlled trial compared the pain relieving effect of sublingual fentanyl and placebo during BMAB.
  
  
  METHODS
  One hundred sixty patients were randomized to receive either sublingual fentanyl 200 μg, 100 μg (patients ≥ 70 years old, weight ≤ 50 kg or in poor health) or placebo before BMAB. The grade of anxiety before the procedure and the grade of pain during local anaesthetic infiltration, aspiration, biopsy and immediately after the BMAB were assessed using the Numeral Rating Scale (0-10). Possible side effects of the study drugs were recorded.
  
  
  RESULTS
  Sublingual fentanyl proved inadequate in relieving pain during BMAB as no significant differences in the pain scores of the fentanyl and placebo patients were observed. However, fentanyl caused significantly more dizziness than placebo.
  
  
  CONCLUSIONS
  The results suggest that sublingual fentanyl in a dose of 200 μg (100 μg in infirm patients) is not a feasible preventive analgesic during BMAB. Pain scores were similar and side effects more frequent in the fentanyl group than in the placebo group.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University of Helsinki, Finland. anna-maria.kuivalainen@helsinki.fi
authors.forename: A-M
authors.initials: AM
authors.lastname: Kuivalainen
authors.forename: F
authors.initials: F
authors.lastname: Ebeling
authors.forename: P H
authors.initials: PH
authors.lastname: Rosenberg
mesh_terms: D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D001707:Biopsy, Needle / Q000009:adverse effects*; D001853:Bone Marrow / Q000473:pathology*; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl