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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures
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Local Anesthesia With General Anesthesia for Pediatric Bone Marrow Procedures

机译：局部麻醉与海洋骨髓手术的全身麻醉

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BACKGROUND: Pediatric patients with cancer undergo repeated painful procedures, including bone marrow aspirations and biopsies (BMABs). Optimal management of procedure-related pain can reduce discomfort, anxiety, and distress. METHODS: Children with neuroblastoma were randomly assigned to 1 of 2 arms on a prospective, single-blind, crossover trial conducted at Memorial Sloan Kettering Cancer Center from October 2016 to January 2018 (, identifier NCT02924324). Participants underwent 2 sequential BMABs: one with general anesthesia (GA) alone, the other with GA plus local anesthesia (LA) (GA + LA). The objective was to assess procedure-related pain and its interference with quality of life (QoL) with GA versus GA + LA. Primary outcome was percentage of participants requiring postprocedural opioids. Secondary outcomes were total opioid and nonopioid analgesics, pain scores, time to first analgesic, QoL, and toxicity. Management of postprocedural pain was standardized. RESULTS: Of 56 participants randomly assigned (3-16.5 years old), 46 completed both procedures. There was no significant difference in percentage of participants requiring opioids with GA versus GA + LA (24% vs 20%, P = .5). Pain scores in the recovery room were significantly lower for GA + LA versus GA (median [IQR]: 0 [0-2] vs 2 [0-4], P = .002). There were no statistically significant differences in total opioid or nonopioid analgesic, 6- and 24-hour pain scores, median time to first analgesic, or pain interference. No adverse events occurred. CONCLUSIONS: LA was associated with significant improvement in pain scores in the immediate recovery period. LA did not reduce postprocedural opioid use, nor did it improve QoL for patients undergoing BMAB with GA.
机译：背景：癌症的儿科患者经历重复的痛苦程序，包括骨髓抱负和活组织检查（BMAB）。程序相关疼痛的最佳管理可以减少不适，焦虑和痛苦。方法：在2016年10月至2018年1月（标识符NCT02924324）中，随机将神经母细胞瘤随机分配给2个武器中的1个武器中的1个。参与者接受了2个顺序BMAB：单独使用全身麻醉（GA），另一种具有Ga加局部麻醉（La）（Ga + La）。目的是评估与GA与GA + La的寿命和生命质量（QOL）的干扰。主要结果是需要骨膜前述阿片类药物的参与者的百分比。二次结果是总阿片类药物和非磷酸盐镇痛药，疼痛评分，第一次镇痛，QOL和毒性的时间。后期疼痛的管理是标准化的。结果：56名参与者随机分配（3-16.5岁），46次完成两项程序。需要与Ga与Ga + La的阿片类药物的参与者百分比没有显着差异（24％vs 20％，p = .5）。 GA + LA与GA（中位数[IQR]：0 [0-2] VS 2 [0-4]，P = .002），恢复室中的疼痛评分显着降低。总阿片类药物或非磷酸盐镇痛，6-醇和24小时疼痛评分，中位时间与第一镇痛或疼痛干扰的总差异。没有发生不良事件。结论：LA与直接恢复期间疼痛评分的显着改善有关。 La没有减少后期的阿片类药物使用，也没有改善与GA接受BMAB的患者的QoL。

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