Use of combined oral narcotic and benzodiazepine for control of pain associated with bone marrow examination

Background. Bone marrow aspirate and biopsy is universally recognized as being painful. Few descriptions of effective analgesia or premedication for this procedure exist. In this study, we assessed an oral narcotic and benzodiazepine combination in controlling pain associated with bone marrow examination. Methods. Twenty-four consecutive ambulatory, adult patients referred for bone marrow examination received oral medications 90 minutes before the scheduled procedure. Patients reported perceived pain, using both Likert numerical and "Faces Pain Rating Scale," immediately after bone marrow examination and within 1 week after the procedure. Physicians' and nurses' evaluations of patient tolerance and the patients' memories of the aspiration and biopsy were recorded. Results. Two thirds (66%) of the respondents reported none or only mild pain (3 or less on a scale of 1 to 10). Memory of the procedure was vague or nonexistent in approximately half of the patients. There were no complications of biopsies or premedication. Conclusions. Premedication with oral narcotic and benzodiazepine is effective in preventing or lessening pain associated with bone marrow examination in adults. Premedication induces amnesia for some or most of the procedure in about half of the patients.