428P - A pilot study on comparative efficacy of tramadol or eutectic mixture of local anaesthetics (prilocaine plus lignocaine) in preventing bone marrow aspiration associated pain

Background

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 anaesthetics (prilocaine plus lignocaine) (EMLA) for reducing the severity of pain.

Methods

In this pilot study, we compared the addition of either Tramadol 50 mg per oral (Arm T) or EMLA local application (Arm E) or no added intervention (Arm L) in addition to local infiltration with lignocaine 2% before bone marrow aspiration in adults suspected / confirmed with malignancy. Both, tramadol and EMLA were administered one hour prior to the procedure. Primary end point was reduction in pain intensity with these interventions compared to local infiltration alone. Pain was assessed using numerical FACES pain scale ( 0-10), a visual analogue scale.Secondary end points were to see the effect on pre procedure apprehension and to find out other factors associated with increased pain associated with the procedure.

Results

A total of 225 patients were included in the study, 75 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 tramadol arm ( T,E,L - 3.3 , 4.5 , 4.7 respeactively)(p < 0.05). There was significant reduction in percentage of patients who experienced moderate / severe pain (4 or more) in tramadol arm (T,E,L - 47%,76%,84% respectively)(p < 0.05). Duration of procedure > 10 minutes and age > 50 were positively correlated with more pain. Leukemia patients had significantly more pain compared to lymphoma and other solid malignancies. Only 4 patients had sedation/dizziness in tramadol arm compared to 2 each in the other two arms. No significant effect on pre procedure apprehension was noted in any of the arms.

Conclusions

Tramadol appears to have a preventive effect on bone marrow aspiration associated pain and appears to be well tolerated. Whereas EMLA was not associated with such effect. Larger studies may be done to ascertain the same.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Department of medical oncology, Kidwai cancer institute.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.