ABSTRACT
Bone marrow aspiration and biopsy is a procedure of central importance in the diagnosis of haematological disease and is one that can be safely performed in the outpatient clinic using only local anaesthesia. We evaluated the role of inhaled nitrous oxide (Entonox) as an adjuvant to local anaesthesia (LA) in patients requiring bone examination. We prospectively studied the role of Entonox in patients attending our outpatient department who required bone marrow examination. All patients received LA with injected 2% lignocaine but patients were then assigned to either LA alone or LA plus inhaled Entonox. Following the procedure patients were given a questionnaire and asked to score the discomfort associated with the procedure. Twenty-eight of 85 patients (33%) who received LA alone scored their pain as 3 (severe) compared with seven of 51 patients (14%) who received LA plus Entonox, P = 0.013. No adverse events were associated with Entonox use. Forty-three of the 51 patients who received Entonox stated that they would prefer to use this method of anaesthesia again. We conclude that inhaled Entonox is a useful adjuvant to local anaesthesia for patients undergoing bone marrow examination.
Subject(s)
Anesthetics, Combined/administration & dosage , Anesthetics, Local/administration & dosage , Bone Marrow Examination/adverse effects , Lidocaine/administration & dosage , Nitrous Oxide/administration & dosage , Oxygen/administration & dosage , Pain/prevention & control , Administration, Inhalation , Drug Therapy, Combination , Humans , Pain/etiology , Pain Measurement/methods , Prospective Studies , Treatment OutcomeSubject(s)
Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Lymphoma, Large B-Cell, Diffuse/diagnosis , Lymphoma, Non-Hodgkin/diagnosis , Nose Neoplasms/diagnosis , Antibodies, Monoclonal/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow Transplantation , Cyclophosphamide/therapeutic use , Doxorubicin/therapeutic use , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Lymphoma, Large B-Cell, Diffuse/therapy , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Nose Neoplasms/therapy , Prednisone/therapeutic use , Syndrome , Vincristine/therapeutic useABSTRACT
We describe four patients with von Willebrand's disease (VWD) who experienced venous thrombosis after treatment with an intermediate purity factor VIII (FVIII) concentrate (Haemate P3) was used to cover invasive or surgical procedures. Most patients had additional risk factors for venous thromboembolism (VTE) and it is difficult to be certain of the contribution of the concentrate to the VTE. In view of the recognised association between high factor VIII activity (FVIII:C) levels and VTE there is a physiological basis for this complication and it is important to consider this when administering FVIII containing concentrates to VWD patients.
