Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures

Sara Zarnegar-Lumley, Katharine R. Lange, Melissa D. Mathias, Miho Nakajima-Hatano, Katharine M. Offer, Ugochi O. Ogu, Michael V. Ortiz, Kay See Tan, Michael Kellick, Shakeel Modak, Stephen S. Roberts, Ellen M. Basu, Robert Dingeman

Research output: Contribution to journalArticle

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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%, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .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. CONCLUSIONS: 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.

Original languageEnglish (US)
JournalPediatrics
Volume144
Issue number2
DOIs
StatePublished - Aug 1 2019

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Local Anesthesia
General Anesthesia
Bone Marrow
Pediatrics
Opioid Analgesics
Pain
Needle Biopsy
Non-Narcotic Analgesics
Quality of Life
Analgesics
Recovery Room
Pain Management
Neuroblastoma
Cross-Over Studies
Neoplasms
Anxiety

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Zarnegar-Lumley, S., Lange, K. R., Mathias, M. D., Nakajima-Hatano, M., Offer, K. M., Ogu, U. O., ... Dingeman, R. (2019). Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures. Pediatrics, 144(2). https://doi.org/10.1542/peds.2018-3829

Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures. / Zarnegar-Lumley, Sara; Lange, Katharine R.; Mathias, Melissa D.; Nakajima-Hatano, Miho; Offer, Katharine M.; Ogu, Ugochi O.; Ortiz, Michael V.; Tan, Kay See; Kellick, Michael; Modak, Shakeel; Roberts, Stephen S.; Basu, Ellen M.; Dingeman, Robert.

In: Pediatrics, Vol. 144, No. 2, 01.08.2019.

Research output: Contribution to journalArticle

Zarnegar-Lumley, S, Lange, KR, Mathias, MD, Nakajima-Hatano, M, Offer, KM, Ogu, UO, Ortiz, MV, Tan, KS, Kellick, M, Modak, S, Roberts, SS, Basu, EM & Dingeman, R 2019, 'Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures', Pediatrics, vol. 144, no. 2. https://doi.org/10.1542/peds.2018-3829
Zarnegar-Lumley S, Lange KR, Mathias MD, Nakajima-Hatano M, Offer KM, Ogu UO et al. Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures. Pediatrics. 2019 Aug 1;144(2). https://doi.org/10.1542/peds.2018-3829
Zarnegar-Lumley, Sara ; Lange, Katharine R. ; Mathias, Melissa D. ; Nakajima-Hatano, Miho ; Offer, Katharine M. ; Ogu, Ugochi O. ; Ortiz, Michael V. ; Tan, Kay See ; Kellick, Michael ; Modak, Shakeel ; Roberts, Stephen S. ; Basu, Ellen M. ; Dingeman, Robert. / Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures. In: Pediatrics. 2019 ; Vol. 144, No. 2.
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abstract = "BACKGROUND: 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. METHODS: 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. RESULTS: 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{\%}, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .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. CONCLUSIONS: 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.",
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AU - Lange, Katharine R.

AU - Mathias, Melissa D.

AU - Nakajima-Hatano, Miho

AU - Offer, Katharine M.

AU - Ogu, Ugochi O.

AU - Ortiz, Michael V.

AU - Tan, Kay See

AU - Kellick, Michael

AU - Modak, Shakeel

AU - Roberts, Stephen S.

AU - Basu, Ellen M.

AU - Dingeman, Robert

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N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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%, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .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. CONCLUSIONS: 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.

AB - BACKGROUND: 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. METHODS: 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. RESULTS: 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%, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .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. CONCLUSIONS: 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.

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