Painful bone marrow aspiration and biopsy: How to approach – pro
The great majority of these procedures are performed with local anesthesia only. Where more anesthesia is requested, other options are available. So far, there is no formal recommendation on how to effectively reduce pain during the bone marrow biopsy. However, the data collected during different trials and the experience from different centers show that simple conclusions can be drawn. Firstly, the emphasis should be focused on patient information. The doctors should inform the patient about the procedure and provide necessary information on what will be done. Secondly, the first biopsy should preferably be performed by an experienced operator as this is the point where the greatest anxiety is felt, and pain during that first procedure was shown to be connected with pain in the following biopsies. When possible, we would recommend sending psychologically fragile patients undergoing their first BMBA to a physician in a center known to perform the least painful BMBA. Additionally, better pharmacological ways for patient anesthesia and sedation should be explored. The patients should be carefully anesthetized, and the local anesthetic, allowed time for proper infiltration of the puncture site. Insufficient local anesthesia is the most easily avoidable mistake during bone marrow biopsies. Short sedations can be offered to patients preferring pain relief, if the ward has the capacity of providing the possibility for further observation. For patients experiencing severe pain during the marrow suction, tramadol can be given before the procedure, as it was shown to significantly reduce this pain. The patient should be asked when the strongest pain was experienced during the previous procedure, as this provides the operator with information on possible pain-causing factors and allows in many cases the improvement in following biopsies.
In many institutions and certainly recommended for any patient who can be anticipated to either not tolerate or have difficulty in obtaining an adequate specimen, Interventional Radiology can perform the procedure under imaging.
Sollazzo F et al, Bone marrow aspiration and biopsy-related pain management. Ann Hematol. 2014 Jun;93(6):1061-2.
Zahid MF. Methods of reducing pain during bone marrow biopsy: a narrative review. Ann Palliat Med. 2015 Oct. 4 (4):184-93.
Nikolaj Hjortholm et al, Strategies of pain reduction during the bone marrow biopsy, Ann Hematol. 2013 Feb; 92(2): 145–149.