Abstract
The assessment and management of pain and anxiety related to a bone marrow aspiration and biopsy (BM asp/bx) has received little attention, despite the frequent use of this procedure, and the availability of safe and rapid-acting IV anesthetics. We sought to quantify the severity of pain and anxiety associated with BM asp/bx and to test a protocol using anesthesiologist-administered IV Propofol to prevent procedure-related pain and anxiety. After signing an informed consent, 82 adult patients (pts) participated in the study. The first 45 pts received a BM asp/bx performed in the routine fashion (control cohort). The next 37 pts participated in the Pain-Free Bone Marrow Protocol and received IV Propofol during their procedure (intervention cohort). Each patient completed pre- and post- BM asp/bx surveys. Visual analogue scales (VAS) were used to measure pain and anxiety/concern. Analysis was performed on the total number of patients for whom complete data was available (Table 1 N=65; Table 2 N=70). A multi-departmental study team was necessary to support the Hematology practice change to incorporate the pain-free BM asp/bx option.
Bone Marrow Procedure-related Pain and Anxiety: VAS score: Median ( IQ range)
| Question . | Control n=34 . | Intervention n=31 . |
|---|---|---|
| (VAS: 0=no pain/anxiety 100=most pain/anxiety) *ρ=0.001 | ||
| Rate the most severe level of pain | 40 (23–62) | 6 (1–17)* |
| Rate your expected level of pain for the BM asp/bx | 47 (21–76) | 15 (2–26)* |
| Rate your pre-BM asp/bx level of anxiety | 37 (11–76) | 29 (7–46) |
| Question . | Control n=34 . | Intervention n=31 . |
|---|---|---|
| (VAS: 0=no pain/anxiety 100=most pain/anxiety) *ρ=0.001 | ||
| Rate the most severe level of pain | 40 (23–62) | 6 (1–17)* |
| Rate your expected level of pain for the BM asp/bx | 47 (21–76) | 15 (2–26)* |
| Rate your pre-BM asp/bx level of anxiety | 37 (11–76) | 29 (7–46) |
Concern for Future Bone Marrow Aspirate/Biopsy
| Question . | Control N=38 . | Intervention N=32 . |
|---|---|---|
| *ρ =0.008 **ρ =0.000 (Total Control Group v Total Intervention Group) | ||
| How concerned are you about needing a future BM asp/bx? ( VAS: 0= no concern 100=most concern) | 15; 0–45 | 0; 0–6* |
| Given the choice, would you opt for a pain-free BM asp/bx in the future? | Yes = 15; 44% | Yes = 30; 97%** |
| No = 14; 41% | No = 0; 0% | |
| Unsure = 5;15% | Unsure = 1;0% | |
| Question . | Control N=38 . | Intervention N=32 . |
|---|---|---|
| *ρ =0.008 **ρ =0.000 (Total Control Group v Total Intervention Group) | ||
| How concerned are you about needing a future BM asp/bx? ( VAS: 0= no concern 100=most concern) | 15; 0–45 | 0; 0–6* |
| Given the choice, would you opt for a pain-free BM asp/bx in the future? | Yes = 15; 44% | Yes = 30; 97%** |
| No = 14; 41% | No = 0; 0% | |
| Unsure = 5;15% | Unsure = 1;0% | |
Patients in the intervention cohort expected and experienced significantly less pain during their BM asp/bx. Patients in the intervention cohort had less concern regarding possible future BM asp/bx. A meaningful majority of patients would elect a pain-free BM asp/bx in the future if given the option.
Our data demonstrate that BM asp/bx performed in the routine fashion is moderately painful and is associated with moderate pre-procedure anxiety. Our protocol using propofol anesthesia successfully reduced expected and experienced BM asp/bx-related pain for the current procedure and potential future procedures.
In our sample, the majority of adult hematology patients would elect a pain-free bone marrow aspiration and biopsy procedure if given the option.
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