Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures

• Published in: Pediatrics (Evanston) 2019-08, Vol.144 (2), p.e20183829
• Main Authors: Zarnegar-Lumley, Sara, Lange, Katharine R, Mathias, Melissa D, Nakajima-Hatano, Miho, Offer, Katharine M, Ogu, Ugochi O, Ortiz, Michael V, Tan, Kay See, Kellick, Michael, Modak, Shakeel, Roberts, Stephen S, Basu, Ellen M, Dingeman, R Scott
• Format: Article
• Language: English
• Subjects: Analgesics; Anesthesia; Anesthesia, General - methods; Anesthesia, Local - methods; Anxiety; Biopsy; Biopsy - adverse effects; Biopsy - trends; Bone marrow; Bone Marrow - pathology; Bone marrow biopsy; Bone marrow examination; Care and treatment; Child; Child, Preschool; Control; Cross-Over Studies; Female; General anesthesia; Humans; Local anesthesia; Male; Methods; Narcotics; Neuroblastoma; Neuroblastoma - diagnosis; Neuroblastoma - surgery; Opioids; Pain; Pain management; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Pediatric research; Pediatrics; Prospective Studies; Quality of life; Single-Blind Method; Statistical analysis; Toxicity
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2018-3829

Pediatric patients with cancer undergo repeated painful procedures, including bone marrow aspirations and biopsies (BMABs). Optimal management of procedure-related pain can reduce discomfort, anxiety, and distress. Children with neuroblastoma were randomly assigned to 1 of 2 arms on a prospective, single-blind, crossover trial conducted at Memorial Sloan Kettering Cancer Center from October 2016 to January 2018 (www.clinicaltrials.gov, identifier NCT02924324). Participants underwent 2 sequential BMABs: one with general anesthesia (GA) alone, the other with GA plus local anesthesia (LA) (GA + LA). The objective was to assess procedure-related pain and its interference with quality of life (QoL) with GA versus GA + LA. Primary outcome was percentage of participants requiring postprocedural opioids. Secondary outcomes were total opioid and nonopioid analgesics, pain scores, time to first analgesic, QoL, and toxicity. Management of postprocedural pain was standardized. Of 56 participants randomly assigned (3-16.5 years old), 46 completed both procedures. There was no significant difference in percentage of participants requiring opioids with GA versus GA + LA (24% vs 20%, = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], = .002). There were no statistically significant differences in total opioid or nonopioid analgesic, 6- and 24-hour pain scores, median time to first analgesic, or pain interference. No adverse events occurred. LA was associated with significant improvement in pain scores in the immediate recovery period. LA did not reduce postprocedural opioid use, nor did it improve QoL for patients undergoing BMAB with GA.