Departments of Pediatrics,
Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Pediatrics. 2019 Aug;144(2). 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.
患有癌症的儿科患者需要接受多次有创性操作，包括骨髓穿刺和活检（BMAB）。优化操作相关疼痛的管理可以减轻不适、焦虑和痛苦。
在 2016 年 10 月至 2018 年 1 月期间，在纪念斯隆凯特琳癌症中心（Memorial Sloan Kettering Cancer Center）进行了一项前瞻性、单盲、交叉试验，将神经母细胞瘤患儿随机分配至 2 个治疗组（www.clinicaltrials.gov，标识符 NCT02924324）。参与者接受了 2 次连续的 BMAB：1 次单独使用全身麻醉（GA），另 1 次使用 GA 加局部麻醉（LA）（GA + LA）。目的是评估 GA 与 GA + LA 对操作相关疼痛及其对生活质量（QoL）的影响。主要结局指标是需要术后阿片类药物的参与者比例。次要结局指标是总阿片类药物和非阿片类药物镇痛剂、疼痛评分、首次镇痛时间、QoL 和毒性。术后疼痛管理标准化。
在 56 名随机分配的参与者（3-16.5 岁）中，46 名完成了 2 次操作。GA 与 GA + LA 组需要阿片类药物的参与者比例无显著差异（24% vs 20%， =.5）。GA + LA 组在恢复室的疼痛评分明显低于 GA 组（中位数[IQR]：0 [0-2] vs 2 [0-4]， =.002）。GA + LA 组与 GA 组在总阿片类药物或非阿片类药物镇痛剂、6 小时和 24 小时疼痛评分、首次镇痛时间或疼痛干扰方面无统计学差异。无不良事件发生。
LA 可显著改善操作后即刻恢复期的疼痛评分。LA 并未减少术后阿片类药物的使用，也未改善 GA 下接受 BMAB 的患者的 QoL。
