Kuivalainen Anna-Maria, Pitkäniemi Janne, Widenius Tom, Elonen Erkki, Rosenberg Per
Department of Anaesthesiology and Intensive Care Medicine, University of Helsinki, Helsinki Finland.
Department of Public Health, University of Helsinki, Helsinki Finland.
Scand J Pain. 2012 Apr 1;3(2):92-96. doi: 10.1016/j.sjpain.2011.11.002.
Background Previously we found that pre-procedural nervousness and tension (translated into English as "anxiety"), assessed on a non-validated five-point scale, correlated with pain intensity of the various stages of bone marrow aspiration and biopsy (BMAB). The fewer the previous BMAB procedures the stronger the pain from a repeated procedure. The primary purpose of the present observational study is to evaluate the state of anxiety just before BMAB and to find out whether it affects the pain experiences during the various stages of the BMAB procedure. We also examined whether first-timers differ from patients with previous BMAB experience in the degree of anxiety and intensity of BMAB procedural pain. Methods A total of 166 adult outpatients undergoing the BMAB from the Helsinki University Hospital were enrolled, 48 of them being first-timers. The level of anxiety was measured with State-Trait Anxiety Inventory (STAI) and the pain experiences associated with the various stages of the procedure were evaluated on the NRS-scale (Numeral Rating Scale 0-10) and using the Finnish pain vocabulary. BMAB was planned to be performed under lidocaine infiltration anaesthesia but, on request, patients were allowed to receive premedication with diazepam orally or alfentanil i.m. If, in spite of supplemental local anaesthetic the patient still felt pain from the sampling needle tip, i.m. alfentanil was administered. Results There was a clear association between anxiety and pain during all stages of the procedure, except during biopsy. The NRS scores varied from 0 to 10 in all the various stages of BMAB. The first-timers did not differ from the more experienced patients with regard to pain experiences; only the pain felt during the local anaesthetic infiltration was milder (P = 0.007) in first-timers than in the others. Procedural pain in those who were given analgesic or sedative premedication was similar (P < 0.05) to that in the non-premedicated patients. The words characterizing the pain of the various stages belonged to a major extent (76-90%) to the sensory class of words. Conclusion Pre-procedural anxiety had a major impact on the pain ratings. The first-timers and patients with previous experience of BMAB had a similar degree of pre-procedural anxiety, as well as of the intensity of procedural pain, except that infiltration of local anaesthetic was less painful in the first-timers. Implications Identification of anxious (fearful) patients prior to BMAB, and premedicating them individually may improve satisfaction in both patient and caregiver.
背景 此前我们发现，采用未经验证的五点量表评估的术前紧张和焦虑与骨髓穿刺活检（BMAB）各阶段的疼痛强度相关。既往接受BMAB的次数越少，重复操作时的疼痛越强烈。本观察性研究的主要目的是评估BMAB前的焦虑状态，并确定其是否会影响BMAB过程中各阶段的疼痛体验。我们还研究了首次接受BMAB者与有过BMAB经历的患者在焦虑程度和BMAB操作疼痛强度方面是否存在差异。方法 共有166名来自赫尔辛基大学医院的成年门诊患者接受BMAB，其中48名是首次接受者。采用状态-特质焦虑量表（STAI）测量焦虑水平，并使用数字评定量表（NRS，0-10）和芬兰疼痛词汇评估与操作各阶段相关的疼痛体验。BMAB计划在利多卡因浸润麻醉下进行，但根据患者要求，允许其口服地西泮或肌内注射阿芬太尼进行术前用药。如果尽管补充了局部麻醉药，患者仍感到采样针尖引起的疼痛，则肌内注射阿芬太尼。结果 除活检阶段外，在操作的所有阶段，焦虑与疼痛之间均存在明显关联。在BMAB的各个阶段，NRS评分从0到10不等。首次接受者与经验更丰富的患者在疼痛体验方面没有差异；只有首次接受者在局部麻醉浸润时感觉到的疼痛比其他人更轻（P = 0.007）。接受镇痛或镇静术前用药者的操作疼痛与未用药患者相似（P < 0.05）。描述各阶段疼痛的词汇在很大程度上（76-90%）属于感觉类词汇。结论 术前焦虑对疼痛评分有重大影响。首次接受者和有BMAB既往经验的患者术前焦虑程度以及操作疼痛强度相似，只是首次接受者局部麻醉浸润时的疼痛较轻。意义 在BMAB前识别焦虑（恐惧）患者并对其进行个体化术前用药，可能会提高患者和医护人员的满意度。
