A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain
Objectives Bone marrow aspiration although being a common procedure is associated with significant pain and its reduction remains an unmet need. We evaluated the use of tramadol and eutectic mixture of local anesthetics (prilocaine plus lignocaine) (EMLA) for reducing the severity of pain....
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| Format: | Article |
| Language: | English |
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2021-09-01
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| Series: | South Asian Journal of Cancer |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1731904 |
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| author | AH. Rudresha Bipinesh Sansar D. Lokanath Linu Abraham Jacob M.C. Suresh Babu K. N. Lokesh Smitha C. Saldanha Shina Goyal L. K. Rajeev |
| author_facet | AH. Rudresha Bipinesh Sansar D. Lokanath Linu Abraham Jacob M.C. Suresh Babu K. N. Lokesh Smitha C. Saldanha Shina Goyal L. K. Rajeev |
| author_sort | AH. Rudresha |
| collection | DOAJ |
| description | Objectives Bone marrow aspiration although being a common procedure is associated with significant pain and its reduction remains an unmet need. We evaluated the use of tramadol and eutectic mixture of local anesthetics (prilocaine plus lignocaine) (EMLA) for reducing the severity of pain.
Materials and Methods In this pilot study, we compared the addition of either tramadol 50 mg per oral (T) or EMLA local application (E) or no intervention (L) in addition to the usual procedure of local infiltration with lignocaine 2% before bone marrow aspiration and biopsy (BMAB) in adults suspected/confirmed with malignancy. Both, tramadol and EMLA were administered 1 hour prior to the procedure. Primary end point was reduction in pain intensity with these interventions compared with local infiltration alone. Pain was assessed using numerical FACES pain scale, a visual analogue scale. Secondary end points were to see the effect on pre procedure apprehension and to find out the other factors associated with increased pain related to the procedure.
Statistical Analysis and Results A total of 300 patients were included in the study, 100 each in tramadol (T), EMLA (E), and only lignocaine local infiltration (L) arms, respectively. The mean pain intensity on the visual scale was significantly lower in the tramadol arm (T, E, L—3.4, 4.4, 4.7, respectively) (p < 0.0005). There was a significant reduction in percentage of patients who experienced moderate/severe pain (four or more) in the tramadol arm (T, E, L—45, 77, 82%, respectively) (p < 0.0005). Duration of procedure >10 minutes, body mass index >30, ECOG (Eastern Oncology Group) performance status ≥3, and age >50 years were positively correlated with more pain. Leukemia patients experienced significantly more pain compared with patients with lymphoma and other solid malignancies. Tramadol was well tolerated. No significant effect on pre-procedure apprehension was noted in any of the arms.
Conclusion Tramadol appears to have a preventive effect on bone marrow aspiration/biopsy-associated pain and appears to be well tolerated, whereas EMLA was not associated with such an effect. Larger studies may be done to ascertain the same. |
| first_indexed | 2024-12-24T11:21:30Z |
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| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-12-24T11:21:30Z |
| publishDate | 2021-09-01 |
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| series | South Asian Journal of Cancer |
| spelling | doaj.art-21011420672a4b2f9d2f6af9105946902022-12-21T16:58:14ZengThieme Medical and Scientific Publishers Pvt. Ltd.South Asian Journal of Cancer2278-330X2278-43062021-09-01100319019410.1055/s-0041-1731904A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated PainAH. Rudresha0Bipinesh Sansar1D. Lokanath2Linu Abraham Jacob3M.C. Suresh Babu4K. N. Lokesh5Smitha C. Saldanha6Shina Goyal7L. K. Rajeev8Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaDepartment of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, IndiaObjectives Bone marrow aspiration although being a common procedure is associated with significant pain and its reduction remains an unmet need. We evaluated the use of tramadol and eutectic mixture of local anesthetics (prilocaine plus lignocaine) (EMLA) for reducing the severity of pain. Materials and Methods In this pilot study, we compared the addition of either tramadol 50 mg per oral (T) or EMLA local application (E) or no intervention (L) in addition to the usual procedure of local infiltration with lignocaine 2% before bone marrow aspiration and biopsy (BMAB) in adults suspected/confirmed with malignancy. Both, tramadol and EMLA were administered 1 hour prior to the procedure. Primary end point was reduction in pain intensity with these interventions compared with local infiltration alone. Pain was assessed using numerical FACES pain scale, a visual analogue scale. Secondary end points were to see the effect on pre procedure apprehension and to find out the other factors associated with increased pain related to the procedure. Statistical Analysis and Results A total of 300 patients were included in the study, 100 each in tramadol (T), EMLA (E), and only lignocaine local infiltration (L) arms, respectively. The mean pain intensity on the visual scale was significantly lower in the tramadol arm (T, E, L—3.4, 4.4, 4.7, respectively) (p < 0.0005). There was a significant reduction in percentage of patients who experienced moderate/severe pain (four or more) in the tramadol arm (T, E, L—45, 77, 82%, respectively) (p < 0.0005). Duration of procedure >10 minutes, body mass index >30, ECOG (Eastern Oncology Group) performance status ≥3, and age >50 years were positively correlated with more pain. Leukemia patients experienced significantly more pain compared with patients with lymphoma and other solid malignancies. Tramadol was well tolerated. No significant effect on pre-procedure apprehension was noted in any of the arms. Conclusion Tramadol appears to have a preventive effect on bone marrow aspiration/biopsy-associated pain and appears to be well tolerated, whereas EMLA was not associated with such an effect. Larger studies may be done to ascertain the same.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1731904aspirationbone marrowemlapaintramadol |
| spellingShingle | AH. Rudresha Bipinesh Sansar D. Lokanath Linu Abraham Jacob M.C. Suresh Babu K. N. Lokesh Smitha C. Saldanha Shina Goyal L. K. Rajeev A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain South Asian Journal of Cancer aspiration bone marrow emla pain tramadol |
| title | A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain |
| title_full | A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain |
| title_fullStr | A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain |
| title_full_unstemmed | A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain |
| title_short | A Pilot Study on the Addition of Tramadol or Eutectic Mixture of Local Anesthetics (Prilocaine Plus Lignocaine) to Local Lignocaine Infiltration for Prevention of Bone Marrow Aspiration/Biopsy Associated Pain |
| title_sort | pilot study on the addition of tramadol or eutectic mixture of local anesthetics prilocaine plus lignocaine to local lignocaine infiltration for prevention of bone marrow aspiration biopsy associated pain |
| topic | aspiration bone marrow emla pain tramadol |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0041-1731904 |
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