Use of Buffered Lidocaine in Bone Marrow Biopsies: A Randomized, Controlled Trial

Ruegg, Tracy A.; Curran, Christine R.; Lamb, T. L.

doi:10.1188/09.onf.52-60

Cited by 19 publications

(21 citation statements)

References 21 publications

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“…Some providers elect to use conscious sedation during the bone marrow procedures in an attempt to mitigate procedural pain and discomfort; but this takes longer and may expose the patient to additional physical risks, result in increased liability for the provider, and require increased patient monitoring during and after the procedure [13]. In a study of 138 patients evaluating the effects of lorazepam on pain during bone marrow procedures, Park et al reported mean VAS scores during the bone marrow procedures as 6.0 ± 2.5 for lorazepam vs. 6.2 ± 2.3 for placebo [14].…”

Section: Introductionmentioning

confidence: 99%

Using a Powered Bone Marrow Biopsy System Results in Shorter Procedures, Causes Less Residual Pain to Adult Patients, and Yields Larger Specimens

Berenson

Yellin

Blumenstein³

et al. 2011

Diagn Pathol

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BackgroundIn recent years, a battery-powered bone marrow biopsy system was developed and cleared by the U.S. Food and Drug Administration to allow health care providers to access the bone marrow space quickly and efficiently. A multicenter randomized clinical trial was designed for adult patients to determine if the powered device had advantages over traditional manually-inserted needles in regard to length of procedure, patient pain, complications, user satisfaction, and pathological analysis of the specimens.MethodsAdult patients requiring marrow sampling procedures were randomized for a Manual or Powered device. Visual Analog Scale (VAS) pain scores were captured immediately following the procedure and 1 and 7 days later. Procedure time was measured and core specimens were submitted to pathology for grading.ResultsTen sites enrolled 102 patients into the study (Powered, n = 52; Manual, n = 50). Mean VAS scores for overall procedural pain were not significantly different between the arms (3.8 ± 2.8 for Powered, 3.5 ± 2.3 for Manual [p = 0.623]). A day later, more patients who underwent the Powered procedure were pain-free (67%) than those patients in the Manual group (33%; p = 0.003). One week later, there was no difference (83% for Powered patients; 76% for Manual patients.) Mean procedure time was 102.1 ± 86.4 seconds for the Powered group and 203.1 ± 149.5 seconds for the Manual group (p < 0.001). Pathology assessment was similar in specimen quality, but there was a significant difference in the specimen volume between the devices (Powered: 36.8 ± 21.2 mm3; Manual: 20.4 ± 9.0 mm3; p = 0.039). Two non-serious complications were experienced during Powered procedures (4%); but none during Manual procedures (p = 0.495).ConclusionsThe results of this first trial provide evidence that the Powered device delivers larger-volume bone marrow specimens for pathology evaluation. In addition, bone marrow specimens were secured more rapidly and subjects experienced less intermediate term pain when the Powered device was employed. Further study is needed to determine if clinicians more experienced with the Powered device will be able to use it in a manner that significantly reduces needle insertion pain; and to compare a larger sample of pathology specimens obtained using the Powered device to those obtained using traditional manual biopsy needles.

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Section: Introductionmentioning

confidence: 99%

Using a Powered Bone Marrow Biopsy System Results in Shorter Procedures, Causes Less Residual Pain to Adult Patients, and Yields Larger Specimens

Berenson

Yellin

Blumenstein³

et al. 2011

Diagn Pathol

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“…3 In our study, in which buffered lidocaine was also used, subjects rated their pain at 38.0 on average with the Powered device. When given the opportunity to change the score for the first procedure, the mean pain score for the Powered insertions was reduced to 20.9.…”

Section: Discussionmentioning

confidence: 99%

“…Attempting to mitigate the procedural pain and discomfort, some providers elect to use conscious sedation during the bone marrow procedures; but this may expose the patient to additional physical risks, increased liability to the provider, and a requirement for increased patient monitoring during and after the procedure. 3 …”

Section: Introductionmentioning

confidence: 99%

Powered Bone Marrow Biopsy Procedures Produce Larger Core Specimens, with Less Pain, in Less Time Than with Standard Manual Devices

et al. 2011

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Bone marrow sampling remains essential in the evaluation of hematopoietic and many non-hematopoietic disorders. One common limitation to these procedures is the discomfort experienced by patients. To address whether a Powered biopsy system could reduce discomfort while providing equivalent or better results, we performed a randomized trial in adult volunteers. Twenty-six subjects underwent bilateral biopsies with each device. Core samples were obtained in 66.7% of Manual insertions; 100% of Powered insertions (P=0.002). Initial mean biopsy core lengths were 11.1±4.5 mm for the Manual device; 17.0±6.8 mm for the Powered device (P<0.005). Pathology assessment for the Manual device showed a mean length of 6.1±5.6 mm, width of 1.0±0.7 mm, and volume of 11.0±10.8 mm3. Powered device measurements were mean length of 15.3±6.1 mm, width of 2.0±0.3 mm, and volume of 49.1±21.5 mm3 (P<0.001). The mean time to core ejection was 86 seconds for Manual device; 47 seconds for the Powered device (P<0.001). The mean second look overall pain score was 33.3 for the Manual device; 20.9 for the Powered (P=0.039). We conclude that the Powered biopsy device produces superior sized specimens, with less overall pain, in less time.

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“…28 A randomized control trial of patients with procedural pain who accepted buffered lidocaine solution or unbuffered preparations for LP biopsy procedures revealed that the former did not make LP biopsy less painful than the latter. 29 In a prospective trial, pretreatment with tramadol plus local injection of 2% lidocaine was reportedly associated with less pain intensity than placebo, thereby indicating that it could be a good local anesthetic for LP biopsy combined with local lidocaine injection. 30 Studies demonstrate that lidocaine administration usually causes mild local skin reactions, such as edema, pallor, or erythema, although other severe complications, such as methemoglobinemia, cardiotoxicity, and central nervous system toxicity, can also be encountered.…”

Section: Discussionmentioning

confidence: 99%

A Fixed Nitrous Oxide and Oxygen Mixture for Analgesia in Children With Leukemia With Lumbar Puncture–induced Pain: A Randomized, Double-blind Controlled Trial

Liu

Chai

Wang

et al. 2019

Journal of Pain and Symptom Management

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Context. Leukemia is the most common cancer in the childhood population. Lumbar puncture (LP) plays central role in the diagnosis and treatment process, but options for analgesia are limited.Objectives. The present study aims to evaluate the efficacy of a fixed N 2 O/O 2 mixture to reduce pain in children with leukemia during LP as compared with placebo.Methods. A double-blind, placebo-controlled, and randomized clinical trial involving children who needed LP for diagnosis or treatment was conducted in the pediatrics department of the General Hospital of Ningxia Medical University. Eligible patients were randomly assigned to inhale either a fixed N 2 O/O 2 mixture or O 2 . The primary endpoint was the maximal pain level felt by the patient during the procedure measured using a numerical rating scale (0e10).Results. One-hundred fourteen consecutive patients were enrolled in this study and randomized. Pain scores during the procedure showed a significant decrease in N 2 O/O 2 mixtureetreated patients to 1.05 AE 1.40 versus 8.00 AE 2.13 in controls (P < 0.01). No serious adverse effects were attributed to N 2 O/O 2 mixture inhalation. Analysis of the satisfaction of patients receiving N 2 O/O 2 mixture indicated that medical staff were satisfied with this treatment.Conclusions. This study demonstrated that self-administered fixed N 2 O/O 2 is efficient to reduce pain related to LP in children with leukemia.

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Use of Buffered Lidocaine in Bone Marrow Biopsies: A Randomized, Controlled Trial

Abstract: Advanced practice nurses perform a significant number of bone marrow biopsies and aim to improve patient comfort during invasive procedures. Use of unbuffered lidocaine should be questioned.

Cited by 19 publications

References 21 publications

Using a Powered Bone Marrow Biopsy System Results in Shorter Procedures, Causes Less Residual Pain to Adult Patients, and Yields Larger Specimens

Using a Powered Bone Marrow Biopsy System Results in Shorter Procedures, Causes Less Residual Pain to Adult Patients, and Yields Larger Specimens

Powered Bone Marrow Biopsy Procedures Produce Larger Core Specimens, with Less Pain, in Less Time Than with Standard Manual Devices

A Fixed Nitrous Oxide and Oxygen Mixture for Analgesia in Children With Leukemia With Lumbar Puncture–induced Pain: A Randomized, Double-blind Controlled Trial

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