Gayet S, Bernit E, Sati H, Veit V, Mazodier K, Schleinitz N, Kaplanski G, Harlé J-R
Service de médecine interne, CHU La Conception, 147, boulevard Baille, 13005 Marseille, France.
Rev Med Interne. 2009 Mar;30(3):208-14. doi: 10.1016/j.revmed.2008.09.006. Epub 2008 Nov 6.
During bone-marrow biopsy, one third of patients score their pain as moderate or severe. Combination of analgesic and hypnotic is effective at reducing pain, but prolonged medical surveillance is necessary. The objective of the study was to assess the effectiveness and ease of use of the equimolar nitrous oxide-oxygen mixture (nitrous oxide), a short acting analgesic with little sedative effect, during bone-marrow biopsy.
As part of a non-controlled prospective observational study, patients undergoing a bone-marrow biopsy received nitrous oxide as an adjuvant to local anaesthesia. Facemask was self-maintained. A questionnaire was given after completion of the procedure to assess the pain (with a numerical-rating scale [RS] ranging from 0 to 10) as the main criterion and the ease of the procedure, the tolerance, and satisfaction, as secondary criteria. The physician noted adverse reactions.
Nineteen women and 21 men were included. The median age was 51 years. Ninety percent of patients felt slight pain, less than 5 out of 10 on the RS. Only one patient had difficulty in keeping the mask. A patient experienced nausea and four presented a fleeting euphoria noticed by the physician. Ninety-five of patients wished to use nitrous oxide again should further bone-marrow examinations be necessary.
Nitrous oxide is an effective analgesic when performing bone-marrow biopsies. Ten percent of patients feel a moderate to severe pain instead of one third. Despite some mild side effects, there is a very good appreciation by patients. Since this study, the authors routinely use nitrous oxide.
在骨髓活检过程中，三分之一的患者将疼痛评为中度或重度。镇痛剂与催眠剂联合使用对减轻疼痛有效，但需要长期医疗监测。本研究的目的是评估等摩尔一氧化二氮 - 氧气混合气体（一氧化二氮）在骨髓活检过程中的有效性和易用性，一氧化二氮是一种短效镇痛药，镇静作用轻微。
作为一项非对照前瞻性观察性研究的一部分，接受骨髓活检的患者接受一氧化二氮作为局部麻醉的辅助用药。面罩由患者自行维持。在操作完成后发放问卷，以疼痛（采用0至10的数字评分量表[RS]）作为主要标准，评估操作的难易程度、耐受性和满意度作为次要标准。医生记录不良反应。
纳入19名女性和21名男性。中位年龄为51岁。90%的患者感到轻微疼痛，RS评分低于5分（满分10分）。只有一名患者难以保持面罩。一名患者出现恶心，四名患者出现医生注意到的短暂欣快感。95%的患者表示如果需要进一步进行骨髓检查，希望再次使用一氧化二氮。
在进行骨髓活检时，一氧化二氮是一种有效的镇痛药。10%的患者感到中度至重度疼痛，而非三分之一。尽管有一些轻微的副作用，但患者对此评价很高。自本研究以来，作者常规使用一氧化二氮。
