Vanhelleputte Philine, Nijs Kristel, Delforge Michel, Evers Georges, Vanderschueren Steven
Center for Hospital Services and Nursing Research, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium.
J Pain Symptom Manage. 2003 Sep;26(3):860-6. doi: 10.1016/s0885-3924(03)00312-9.
The prevalence, intensity, determinants and prevention of pain during bone marrow aspiration (BMA) in adults are not well defined. In the first part of this prospective study (observational phase), 132 adult hematological patients undergoing BMA after local anesthesia scored the procedural pain by means of a visual analogue scale (VAS). Moderate to severe pain was defined as a VAS score exceeding 30 mm. Eighty-six percent reported procedural pain. The VAS score (mean+/-SEM) was 27.2+/-2.1 mm. Thirty-six percent of patients graded the pain as moderate to severe. In a linear regression analysis, VAS score correlated positively with the duration of the procedure (P=0.029) and negatively with the age of the patient (P=0.006). In the second part of the study (interventional phase), 100 patients were randomized to 50 mg tramadol or placebo, given orally at least one hour before BMA. VAS scores during aspiration were significantly lower in tramadol recipients versus placebo recipients (16.5+/-3.0 mm and 28.8+/-3.4 mm, respectively, P=0.003). Pretreatment with tramadol reduced the percentage of patients with at least moderate pain from 40% to 20% (P=0.029). Four tramadol and 3 placebo recipients reported side effects (dizziness or sedation). In conclusion, notwithstanding local anesthesia, the great majority of adult hematological patients experience transient pain during BMA that is of at least moderate intensity in over a third. Pretreatment with tramadol lowers pain intensity significantly and is well tolerated.
成人骨髓穿刺术（BMA）期间疼痛的患病率、强度、决定因素及预防尚不明确。在这项前瞻性研究的第一部分（观察阶段），132例接受局部麻醉后进行BMA的成年血液学患者通过视觉模拟量表（VAS）对操作过程中的疼痛进行评分。中度至重度疼痛定义为VAS评分超过30mm。86%的患者报告有操作过程中的疼痛。VAS评分（均值±标准误）为27.2±2.1mm。36%的患者将疼痛评为中度至重度。在线性回归分析中，VAS评分与操作持续时间呈正相关（P = 0.029），与患者年龄呈负相关（P = 0.006）。在研究的第二部分（干预阶段），100例患者被随机分为两组，分别口服50mg曲马多或安慰剂，在BMA前至少1小时给药。曲马多组患者穿刺时的VAS评分显著低于安慰剂组（分别为16.5±3.0mm和28.8±3.4mm，P = 0.003）。曲马多预处理使至少中度疼痛患者的比例从40%降至20%（P = 0.029）。4例曲马多组和3例安慰剂组患者报告有副作用（头晕或镇静）。总之，尽管采用了局部麻醉，但绝大多数成年血液学患者在BMA期间仍会经历短暂疼痛，其中超过三分之一的患者疼痛强度至少为中度。曲马多预处理可显著降低疼痛强度，且耐受性良好。
