IEO, European Institute of Oncology IRCCS, Milan, Italy.
Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Pain Manag Nurs. 2021 Jun;22(3):349-355. doi: 10.1016/j.pmn.2020.09.005. Epub 2020 Oct 24.
Bone marrow aspiration (BMA) or biopsy is a necessary and frequent procedure for diagnosis and monitoring of hematological diseases. Pharmacological pain management approaches exist; however, previous experience and psychological preparation for BMA may impact pain perception.
This study aimed to explore current practices in procedural pain management for BMA or biopsy.
DESIGN/SETTING/PARTICIPANTS: A cross-sectional internet-based survey was performed by the Nurses Group of the Italian Transplant Group (GITMO). Participants were nurses working in bone marrow transplant centers regularly performing BMA/biopsies.
Sixty out of 94 centers receiving the survey responded (63.8%), 47 adult and 13 pediatric centers. The majority of them (75%) provided only verbal information for patient preparation before BMA. . Injected local anesthetics were used in 55.4% of centers, and combined with topical anesthetics in 33.9% of centers. Use of oral anesthetics was rare; however, anxiolytics and benzodiazepines were occasionally used (18.3%, 18.3% respectively). All pediatric centers used deep sedation for the procedure (p < .001), but drug choice depended on anesthetist preference. Ice packs (35.0%) and oral analgesia as required (40.0%) were used for postprocedural pain. Nurses perceived their patients' pain scores as relatively low (3.5 on scale 0-10), but recognized that it was a painful procedure provoking anxiety, and that pain management could be improved.
Results revealed the lack of a standardized approach to procedural pain management for BMA in this study sample. Assessing a patient's pain experience is a key component to identifying effective pain management for BMA.
骨髓穿刺（BMA）或活检是诊断和监测血液疾病所必需且频繁进行的程序。目前存在药理学疼痛管理方法；然而，BMA 之前的经验和心理准备可能会影响疼痛感知。
本研究旨在探讨 BMA 或活检程序疼痛管理的当前实践。
设计/设置/参与者：意大利移植组（GITMO）护士组进行了一项基于互联网的横断面调查。参与者为定期进行 BMA/活检的骨髓移植中心的护士。
收到调查的 94 个中心中有 60 个（63.8%）做出了回应，其中 47 个为成人中心，13 个为儿科中心。他们中的大多数（75%）仅在 BMA 前为患者提供口头信息。55.4%的中心使用注射局部麻醉剂，33.9%的中心联合使用局部麻醉剂。很少使用口服麻醉剂；然而，偶尔会使用镇静剂和苯二氮䓬类药物（分别为 18.3%和 18.3%）。所有儿科中心都在该程序中使用深度镇静（p<.001），但药物选择取决于麻醉师的偏好。35.0%的中心使用冰袋，40.0%的中心按需使用口服镇痛剂来缓解术后疼痛。护士认为他们的患者的疼痛评分相对较低（0-10 分的量表上为 3.5 分），但他们认识到这是一个引起焦虑的痛苦程序，并且疼痛管理可以得到改善。
结果显示，在本研究样本中，BMA 程序疼痛管理缺乏标准化方法。评估患者的疼痛体验是确定 BMA 有效疼痛管理的关键组成部分。
