Should a marrow draw be painful?

POSTED ON 3/10/2009 IN Archive BY Christopher Centeno

A bone marrow aspirate involves using a needle to take a sample of whole marrow (looks like thick blood) from the back of the hip area (PSIS).  When we first started this medical procedure, we assumed that a bone marrow aspiration must be a very painful process.  As a result, we had an anesthesiologist perform IV sedation on all patients.  One day the anesthetist had a time conflict and we asked the patient if she wanted to proceed.  She said yes.  We appropriately numbed the site and the rest as we say is history.  She had minimal discomfort and actually chided us about wanting to "knock her out".  We were amazed and continued this procedure without anesthesia, only to find the same thing.  I finally met a patient who helped me reconcile our experience with what patients and doctors believe about this procedure.  She had had leukemia many years prior and had marrow aspirates for surveillance of her disease.  These were always painful until she finally met an oncologist who would take the time to numb more than the skin.  With proper numbing, the marrow draws were a breeze.  To better access how our patients feel about this procedure, we ran questionnaires on 44 consecutive patients undergoing marrow draws (primarily in Jan-Feb 2009).  86% said they had no to mild discomfort.  88% said that the procedure was either less uncomfortable or about what they thought it would be.  88% also said they would do it again without hesitation. How do we reconcile these questionnaire results with the bad name this procedure has accumulated through the years?  The difference appears to be in the attention to detail on the numbing process.  Most physicians will only numb the skin.  Another big difference is using x-ray guidance.  We do that to ensure we are getting a real marrow aspirate, but I think it also allows us to see exactly which parts we have numbed and to stay only in that area.  The upshot?  A properly performed marrow aspirate procedure should not be uncomfortable to the vast majority of patients.

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