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Anesthesia

Bone marrow aspiration- anesthesia options

01/31/2008

Question:

I am scheduled for a bone marrow aspiration, which the doctor tells me she will only do with local anesthetic, because anything else is "not necessary." From everything I`ve read about the procedure, it sounds if not deeply painful, at least somewhat painful, and very psychologically stressful. I`ve been under "conscious sedation" or "twilight anesthesia" a couple of times before and it`s really made ALL the difference in making an otherwise very unpleasant experience (say, endoscopy) perfectly painless. So my question is: do some docs do bone marrow aspiration under conscious sedation? Would it behoove me to ask around before having this done? Would really rather do it that way if at all possible.

Answer:

This is not customarily a procedure that anesthesiologists are involved with, except in children. So it's not very painful and, I think, not as unpleasant as an endoscopy.

With adequate local anesthetic and a skillful operator the discomfort should be tolerable. That still leaves you with the stress and anxiety of it a procedure involving a large needle, not to mention the worry you may have about the result of the marrow aspiration, which is done to diagnose blood disorders such as leukemia or lymphoma.

There are non-pharmacologic approaches that can be helpful, such as hypnosis and meditation. There are books and tapes that can teach you how to do this. You could even take your iPod or tape player into the procedure room with you to play a relaxation tape or your favorite music. A kind and caring attitude by the doctor and staff will help you too.

Bone marrow biopsy is not done in an operating room. If you are determined to have some "real" sedation given by an anesthesia provider it might be possible to arrange that in a hospital that has a roving "sedation service" . But it could be that your doctor does not work in that kind of setting or is reluctant to jump through all the hoops logistically and financially to make it happen for you.

Finally, if your doctor can prescribe some preoperative oral sedation (pills) that might be enough to take the edge off your anxiety and allow the procedure to be done in the usual fashion. Keep in mind that if you are sedated you will need someone to drive you home after the procedure.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University