Local anesthesia with general anesthesia for pediatric bone marrow procedures Journal Article


Authors: Zarnegar-Lumley, S.; Lange, K. R.; Mathias, M. D.; Nakajima-Hatano, M.; Offer, K. M.; Ogu, U. O.; Ortiz, M. V.; Tan, K. S.; Kellick, M.; Modak, S.; Roberts, S. S.; Basu, E. M.; Dingeman, R. S.
Article Title: Local anesthesia with general anesthesia for pediatric bone marrow procedures
Abstract: BACKGROUND: 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. METHODS: 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. RESULTS: 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%, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .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. CONCLUSIONS: 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. Copyright © 2019 by the American Academy of Pediatrics.
Journal Title: Pediatrics
Volume: 144
Issue: 2
ISSN: 0031-4005
Publisher: American Academy of Pediatrics  
Date Published: 2019-08-01
Start Page: e20183829
Language: English
DOI: 10.1542/peds.2018-3829
PUBMED: 31366683
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 4 September 2019 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Shakeel Modak
    166 Modak
  2. Michael G Kellick
    12 Kellick
  3. Ellen Marlese Basu
    37 Basu
  4. Stephen Stacy Roberts
    47 Roberts
  5. Melissa Divya Mathias
    15 Mathias
  6. Kay See   Tan
    82 Tan
  7. Michael Vincent Ortiz
    13 Ortiz
  8. Katharine Marie Offer
    3 Offer
  9. Katharine Newcomb Rae
    5 Rae
  10. Ugochi Olivia Ogu
    3 Ogu