Bone marrow harvesting using EMLA (eutectic mixture of local anaesthetics)cream, local anaesthesia and patient-controlled analgesia with alfentanil

Bone marrow harvesting (BMH) was performed on 40 consecutive allogeneic or autologous donors using EMLA (eutectic mixture of local anaesthetics), loca l anaesthesia (LA) and patient-controlled analgesia with alfentanil (PCA-A) , The effect of alkalinizing the LA solution on reducing pain during LA inf iltration in the presence of EMLA was also investigated. EMLA 10 g with occ lusive dressing was applied to the harvest sites at least 60 min before BMH , The PCA device was programmed to deliver an intravenous loading dose of 1 5 mu g/kg alfentanil, followed by a background alfentanil infusion of 0.05 mu g/kg/min. Demand dose was 4 mu g/kg and lockout time was 3 min. Donors w ere randomized to receive either alkalinized (n = 19) or non-alkalinized (n =21) LA solution (lignocaine 1% with 1:100 000 adrenaline). While post-oper ative nausea and vomiting were the only side-effects, all donors in both gr oups reported satisfactory pain scores during LA infiltration and satisfact ory overall intra-operative comfort scores. They completed BMH using either regimen successfully, found this technique acceptable and would recommend this form of anaesthesia to others. Alkalinizing the LA solution did not si gnificantly improve the pain scores during LA infiltration in the presence of EMLA, In conclusion, BMH can be performed safely using EMLA, LA and PCA- A without major complications.