Comparison of articaine and lidocaine for infiltration anaesthesia in patients undergoing bone marrow aspiration and biopsy

Infiltration anaesthesia with articaine, a local anaesthetic able to penetrate bone, may relieve procedural pain better than lidocaine in bone marrow aspiration and biopsy. This randomised, double-blind study comprised 150 patients with suspected or known haematologic disease. Either articaine 20mg/ml (50 patients), articaine 40mg/ml (49 patients) or lidocaine 20mg/ml (51 patients), all with adrenaline 5μg/ml, was infiltrated in volume of 6ml (sternal manubrium), 8ml (sternal body) or 10ml (iliac crest) 2min before puncture. Numeral rating scale score (median, range) at injection of local anaesthetic was 3.0 (0–10), at bone puncture 2.0 (0–8), at aspiration 3.5 (0–10) and at biopsy (48 patients) 3.0 (0–10). Pre-procedural anxiety, rated on a verbal scale, correlated significantly with experienced pain (P<0.01). Very anxious patients had fewer previous bone marrow examinations (P<0.01) and they experienced more pain during aspiration (P<0.05). In the post-interview 42 patients reported appearance of pain (median 2.0, range 1–7) after 6.2h, on average, and 15 patients needed oral analgesics. No parameter differed significantly between the groups.

In conclusion, the quality of infiltration anaesthesia for bone marrow punctures and aspiration with articaine and lidocaine was similarly poor. Several patients experienced strong pain which correlated with the degree of anxiety.