Publication: Estudio comparativo de la sedación consciente asociada a anestesia local para el control de la ansiedad y el dolor en los aspirados/biopsias de médula ósea frente a la práctica habitual con anestesia local
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2017-02-07
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Universidad Complutense de Madrid
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Abstract
El aspirado de médula ósea y el aspirado/biopsia (AMO/BMO) de médula ósea son técnicas fundamentales en el diagnóstico de procesos hematológicos. Estos procedimientos son necesarios para obtener el material, médula ósea y hueso, que es necesario para el análisis citológico, histológico, citogenético, inmunofenotípico y molecular, y que no se puede obtener mediante otros métodos. Se asocia con poca morbilidad y mortalidad, considerándose un procedimiento seguro. Los efectos secundarios de esta técnica son conocidos y están bien descritos, siendo la complicación más frecuente el dolor. A pesar de realizarse desde hace muchos años, y de acuerdo a muchos protocolos diferentes, la técnica prácticamente se ha mantenido inalterada y, hoy en día, el procedimiento continua siendo doloroso para la mayoría de los pacientes pese a la anestesia local. La información acerca de la prevalencia, factores predisponentes y prevención del dolor asociados a esta técnica es limitada. Hasta la fecha, no se ha establecido un factor fuertemente predictivo de dolor. Esto hace difícil predecir qué paciente tendrá más riesgo de sufrir dolor y, por lo tanto, se podrá beneficiar de medidas profilácticas. No existen guías formales en la literatura para el uso de analgesia y ansiolíticos previos a la realización de un AMO/BMO, los procedimientos son variables según los centros y los propios médicos, y sin una estrategia consistente. Se sabe que la anestesia local no produce un grado suficiente de confort ni de control del dolor por lo que se considera importante una mayor investigación para mejorar la práctica clínica y el procedimiento del AMO/BMO...
The bone marrow aspiration and aspiration/biopsy are fundamental techniques in the diagnosis of hematological diseases. These procedures are required to obtain the material, bone marrow and bone, which is necessary for the cytological, histological, cytogenetic, molecular and immunophenotypical analysis, and which cannot be obtained using other methods. It is associated with low morbidity and mortality, and is considered as a safe procedure. The side effects of this technique are well known and well-described, pain being the most frequent complication. In spite of being carried out for many years, and according to many different protocol reviews, the technique has remained largely unchanged, and today the procedure continues to be painful for the majority of patients despite the local anesthesia. There is limited information about the prevalence, predisposing factors and prevention of pain associated with this technique. To date, no one has been able to establish a strongly predictive factor of pain. This makes difficult to predict which patient will present more pain risk and, therefore, may benefit from prophylactic measures. There are no formal guidelines in the literature for the use of analgesia and anxiolytics prior to the execution of BMA/BMB, the procedures may vary for each center and doctor, there's no consistent strategy...
The bone marrow aspiration and aspiration/biopsy are fundamental techniques in the diagnosis of hematological diseases. These procedures are required to obtain the material, bone marrow and bone, which is necessary for the cytological, histological, cytogenetic, molecular and immunophenotypical analysis, and which cannot be obtained using other methods. It is associated with low morbidity and mortality, and is considered as a safe procedure. The side effects of this technique are well known and well-described, pain being the most frequent complication. In spite of being carried out for many years, and according to many different protocol reviews, the technique has remained largely unchanged, and today the procedure continues to be painful for the majority of patients despite the local anesthesia. There is limited information about the prevalence, predisposing factors and prevention of pain associated with this technique. To date, no one has been able to establish a strongly predictive factor of pain. This makes difficult to predict which patient will present more pain risk and, therefore, may benefit from prophylactic measures. There are no formal guidelines in the literature for the use of analgesia and anxiolytics prior to the execution of BMA/BMB, the procedures may vary for each center and doctor, there's no consistent strategy...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina Interna, leída el 26/01/2016