title: Pain management during bone marrow aspiration and biopsy in pediatric cancer patients.
abstract: BACKGROUND
  The pain associated with bone marrow aspiration and biopsy (BMAB) has an enormous impact on pediatric cancer patients and their families, but no specific reference standards for sedation and analgesia have been developed in Japan. To determine the problems associated with pain management during BMAB, a cross-sectional investigation was conducted.
  
  
  METHODS
  A survey was sent in October 2011 to data managers in institutions belonging to the Tokyo Children's Cancer Study Group, addressing the non-pharmacological and pharmacological pain management for BMAB performed on pediatric cancer inpatients between January 2010 and December 2010.
  
  
  RESULTS
  The eligible response rate was 41 of 57 institutions (71.9%). Non-pharmacological pain intervention was provided in 68% of surveyed institutions. All institutions provided pharmacological pain management. In most institutions, sedation/analgesia was performed by pediatric oncologists in a treatment room in the ward. Standards for pain management were developed and utilized in only four institutions. Other means of pain management were provided in various settings. Twelve institutions reported insufficient sedation/analgesia. In total, 80% of institutions reported some adverse events. Two serious adverse events were reported in cases of underlying or complicated conditions. No serious long-term consequences were reported.
  
  
  CONCLUSIONS
  Significant issues were identified regarding the efficacy and safety of pain management. Adverse events can occur in any institution. Children with underlying or complicated conditions are at high risk for serious adverse events. Therefore, adequate and systematic assessment, patient monitoring, preparation and treatment for adverse events, and cooperation with skilled specialists of pediatric oncology, anesthesiology, and intensive care are essential.
authors.affiliation: Tokyo Children's Cancer Study Group, Quality of Life Committee, Tokyo; Department of Pediatrics, Jikei University School of Medicine, Tokyo.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
authors.forename: Miho
authors.initials: M
authors.lastname: Maeda
authors.forename: Yuki
authors.initials: Y
authors.lastname: Aoki
authors.forename: Eizaburo
authors.initials: E
authors.lastname: Ishii
authors.forename: Ysushi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Chikako
authors.initials: C
authors.lastname: Kiyotani
authors.forename: Shoko
authors.initials: S
authors.lastname: Goto
authors.forename: Sachi
authors.initials: S
authors.lastname: Sakaguchi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugita
authors.forename: Mika
authors.initials: M
authors.lastname: Tokuyama
authors.forename: Hisaya
authors.initials: H
authors.lastname: Nakadate
authors.forename: Akira
authors.initials: A
authors.lastname: Kikuchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuchida
authors.forename: Akira
authors.initials: A
authors.lastname: Ohara
mesh_terms: D001707:Biopsy, Needle; D001856:Bone Marrow Examination; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D059408:Pain Management / Q000379:methods*
keywords: adverse events; bone marrow aspiration and biopsy; procedural analgesia; procedural pain; procedural sedation