Evaluation of lidocaine infiltration efficiency for pain relief during bone marrow aspiration in children with cancer

Background: Bone marrow aspiration (BMA) is a painful procedure often requested in paediatric haematology and oncology. The role of local anaesthesia during BMA is matter of debate. This study assessed pain induced by BMA in children who received standard analgesic premedication with or without additional subcutaneous administration of local anaesthesia. Methods: This non-randomised prospective study included 100 patients (age range 5-21 years) who underwent BMA for the diagnosis or treatment of malignancy in a paediatric oncology unit between March 2009 and October 2010. Patients received standard premedication with topical anaesthesia, inhaled nitrous oxide, anxiolytics and analgesics, which was combined or not with administration of local anaesthesia (lidocaine). The children, nurses and doctors all graded procedural pain using a visual analogue scale (VAS). Data were statistically analysed, with each procedure serving as a statistical unit. Results: For 100 BMA procedures performed during the study period, the mean pain rating by children was 2.2, with 38 subjects reporting no pain. Use of lidocaine (19%) induced a mean pain score of 1.6, with 11 patients (57.9%) reporting no pain. Without lidocaine, the mean score was 2.3, and only 27 children (33.3%) reported no pain. Patients undergoing BMA for the first time more frequently graded pain as “0” (p=0.008). Ratings by patients and caregivers correlated poorly; 29.6% of nurses and 34.7% of doctors underestimated procedural pain. Conclusions: Our findings do not clearly demonstrate that addition of local anaesthetic to standard premedication reduces BMA-induced pain. Nevertheless, we provide valuable information on VAS scoring during BMA with standard premedication