Midazolam in conjunction with local anaesthesia is superior to Entonox in providing pain relief during bone marrow aspirate and trephine biopsy

2008 ◽  
Vol 61 (9) ◽  
pp. 1051-1054 ◽  
Author(s):  
G Chakupurakal ◽  
J Delgado ◽  
E Nikolousis ◽  
S Pitchapillai ◽  
D Allotey ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Pain Relief ◽  
Local Anaesthesia ◽  
Respiratory Function ◽  
Bone Marrow Aspirate ◽  
Controlled Trial ◽  
Patient Experiences ◽  
Trephine Biopsy ◽  
Effective Pain Relief ◽  
Randomised Controlled

Aim:To compare intravenous titrated midazolam 5–10 mg and inhaled Entonox in addition to local anaesthesia in order to identify which agent provides optimum pain relief.Methods:Randomised, controlled trial. 49 patients were recruited, of which 46 were evaluable. 24 and 22 patients were recruited into the Entonox and midazolam arms, respectively. Patient experiences as well as staff observations were recorded with questionnaires after recovery from the procedure and 24 hours later.Results:45% and 59% of the patients in the midazolam arm could recollect the procedure after 15 minutes and 24 hours, respectively, compared to 96% and 88% who received Entonox. Midazolam provided a more comfortable experience (p<0.01) and improved pain relief (p = 0.01) compared to Entonox immediately after the procedure; this further improved when recalled 24 hours later. Nausea, dizziness and hallucinations were observed with both treatments, but dizziness was significantly more frequent with Entonox (p = 0.048). Clinically relevant respiratory depression (O2 saturation <90%) occurred in 19% of patients in the midazolam arm; sedation was reversed with flumazenil.Conclusion:Midazolam in conjunction with local anaesthesia provides rapid and reversible sedation as well as effective pain relief during bone marrow biopsy, and is superior to Entonox; however, care must be taken to monitor respiratory function.

scholarly journals Staining of bone marrow aspiration slides: novel immediate staining Vs EDTA–stored samples

2018 ◽  
Vol 6 (6) ◽  
Author(s):  
Asfa Zawar ◽  
Shahzad Ali Jiskani ◽  
Maryam Zulfiqar ◽  
Aliena Sohail ◽  
Asma Mustafa ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Biopsy ◽  
Bone Marrow Aspirate ◽  
Controlled Trial ◽  
Bone Marrow Aspiration ◽  
P Value ◽  
Trephine Biopsy ◽  
Medical Sciences ◽  
Hematoxylin And Eosin

Background: Bone Marrow Biopsy is used as an intervention to diagnose certain hematological and systemic diseases as an adjunct to routine laboratory investigations. The procedure includes getting an aspirate and a trephine biopsy. Slides/Smears are prepared from the aspirate and touch imprints along with Hematoxylin and Eosin (H and E) stained sections are prepared from the trephine. Traditionally the slides from the aspirate have been prepared directly (without anticoagulants) and examined along with the trephine biopsy sections to reach a diagnosis. EDTA (Ethylene Diammine Tetra Acetate) preserved specimen can also be used to make slides of the aspirate. Objective: To compare two methods of bone marrow aspirate preparation. Design of study: Randomized controlled trial. Place of study: Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad Materials and methods: Patients coming to the Department of Pathology for bone marrow biopsy had their samples taken. Half of each sample was used to make direct smears and the other half was preserved in EDTA i.e. the purple top vials. Slides were made at the end of the procedure by the preserved sample and then the two were stained by the same person and procedure (Wright stain) and examined for any differences in quality. SPSS version 21.2 was used to analyze the data. Results: A total of 132 was taken.77 (58.3%) were males and 55(41.7%) were females. 50(37.9%) were adults and 82(62.1%) were children. P–value was found to be 0.81392 which was non-significant proving the fact that the 2 techniques are comparable. Conclusion: EDTA preserved bone marrow aspirate can be used to prepare slides at the end of the whole procedure without compromising the quality of the smears and result interpretation.

A Prospective, Single-Blind, Placebo-Controlled Trial of Bone Marrow Aspirate Concentrate for Knee Osteoarthritis

2016 ◽  
Vol 45 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Shane A. Shapiro ◽  
Shari E. Kazmerchak ◽  
Michael G. Heckman ◽  
Abba C. Zubair ◽  
Mary I. O’Connor
Keyword(s):  
Bone Marrow ◽  
Pain Relief ◽  
Bone Marrow Aspirate ◽  
Controlled Trial ◽  
Joint Disease ◽  
Level Of Evidence ◽  
Serious Adverse Events ◽  
Bone Marrow Aspirate Concentrate ◽  
Early Results ◽  
Single Blind

Background: Bone marrow aspirate concentrate (BMAC) is increasingly used as a regenerative therapy for musculoskeletal pathological conditions despite limited evidence-based support. Hypothesis: BMAC will prove feasible, safe, and efficacious for the treatment of pain due to mild to moderate degenerative joint disease of the knee. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In this prospective, single-blind, placebo-controlled trial, 25 patients with bilateral knee pain from bilateral osteoarthritis were randomized to receive BMAC into one knee and saline placebo into the other. Fifty-two milliliters of bone marrow was aspirated from the iliac crests and concentrated in an automated centrifuge. The resulting BMAC was combined with platelet-poor plasma for an injection into the arthritic knee and was compared with a saline injection into the contralateral knee, thereby utilizing each patient as his or her own control. Safety outcomes, pain relief, and function as measured by Osteoarthritis Research Society International (OARSI) measures and the visual analog scale (VAS) score were tracked initially at 1 week, 3 months, and 6 months after the procedure. Results: There were no serious adverse events from the BMAC procedure. OARSI Intermittent and Constant Osteoarthritis Pain and VAS pain scores in both knees decreased significantly from baseline at 1 week, 3 months, and 6 months ( P ≤ .019 for all). Pain relief, although dramatic, did not differ significantly between treated knees ( P > .09 for all). Conclusion: Early results show that BMAC is safe to use and is a reliable and viable cellular product. Study patients experienced a similar relief of pain in both BMAC- and saline-treated arthritic knees. Further study is required to determine the mechanisms of action, duration of efficacy, optimal frequency of treatments, and regenerative potential. Registration: ClinicalTrials.gov record 12-004459.

scholarly journals A Comparison of Caudal Epidural Bupivacaine with Adrenaline and Bupivacaine with Adrenaline and Pethidine for Operative and Postoperative Analgesia in Infants and Children

1993 ◽  
Vol 21 (4) ◽  
pp. 424-428 ◽  
Author(s):  
T. P. Santhosh Kumar ◽  
R. Jacob
Keyword(s):  
Randomised Controlled Trial ◽  
Pain Relief ◽  
Controlled Trial ◽  
Infants And Children ◽  
Epidural Bupivacaine ◽  
High Incidence ◽  
Randomised Controlled ◽  
Very High ◽  
In Infants And Children ◽  
Caudal Epidural

This study compares the effectiveness of two drug combinations–010-(010a) bupivacaine with adrenaline and (b) bupivacaine with adrenaline and pethidine — on operative and postoperative pain relief when administered by the caudal route in infants and children. A randomised controlled trial was conducted on fifty children below the age of twelve years: 25 children were randomly allocated to each group. Both groups had a significant period of analgesia in the postoperative period. None of the children in either group required parenteral analgesia. Though the group with pethidine had a longer duration of analgesia and sedation, the very high incidence of vomiting and delay in urination observed in this group would preclude the use of pethidine routinely. No respiratory depression was seen in either group.

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