Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics) cream, local anaesthesia and patient-controlled analgesia with alfentanil

Abstract

Summary:Bone marrow harvesting (BMH) was performed on 40 consecutive allogeneic or autologous donors using EMLA (eutectic mixture of local anaesthetics), local anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-A). The effect of alkalinizing the LA solution on reducing pain during LA infiltration in the presence of EMLA was also investigated. EMLA 10 g with occlusive dressing was applied to the harvest sites at least 60 min before BMH. The PCA device was programmed to deliver an intravenous loading dose of 15 g/kg alfentanil, followed by a background alfentanil infusion of 0.05 g/kg/min. Demand dose was 4 g/kg and lockout time was 3 min. Donors were randomized to receive either alkalinized (n = 19) or non-alkalinized (n = 21) LA solution (lignocaine 1% with 1:100 000 adrenaline). While post-operative nausea and vomiting were the only side-effects, all donors in both groups reported satisfactory pain scores during LA infiltration and satisfactory overall intra-operative comfort scores. They completed BMH using either regimen successfully, found this technique acceptable and would recommend this form of anaesthesia to others. Alkalinizing the LA solution did not significantly improve the pain scores during LA infiltration in the presence of EMLA. In conclusion, BMH can be performed safely using EMLA, LA and PCA-A without major complications.

Safe and effective sedation and analgesia for bone marrow aspiration procedures in children with alfentanil, remifentanil and combinations with midazolam

“…used local anaesthesia and patient‐controlled analgesia with alfentanil for bone marrow harvesting. They suggested that this procedure could be performed safely using EMLA, local anesthesia and patient‐controlled analgesia without major complications (20).…”

Hematopoietic stem and progenitor cell harvesting: technical advances and clinical utility

“…It is possible to harvest BM after local anesthesia associated or not with analgesia. 93 Decreases in blood red cell levels are linked to the volume of BM harvested and can be treated by iron supplementation or by autologous red cell transfusion. After the donation, donors usually complain of bone pain.…”

A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain

“…12 Ng et al used EMA along with patient-controlled analgesia with alfentanil and local anesthesia for reducing pain during bone marrow harvesting but they did not compare the effect of addition of EMA on pain reduction. 13 In our study, we found a significant reduction in the pain severity with the use of tramadol 50 mg per oral along with local lignocaine infiltration compared with lignocaine local infiltration alone or EMA cream added to local lignocaine infiltration prior to BMAB. Also, the percentage of patients who experienced moderate or severe pain with BMAB was reduced significantly in the tramadol arm.…”