Painful procedures in children with cancer: comparison of moderate sedation and general anesthesia for lumbar puncture and bone marrow aspiration

BACKGROUND: The study was conducted to compare moderate sedation (MS) with general anesthesia (GA) in the management of frequently performed lumbar puncture or bone marrow aspiration (BMA) during the treatment of childhood cancer. PROCEDURE: The MS (14 patients for 30 procedures) was managed by non-anesthesiologists (combined nitrous oxide-midazolam +/- non-pharmacological techniques). The GA was managed by anesthesiologists (17 patients for 30 procedures). A neutral observer recorded side effects, use of sedative antagonists, recovery time, oncologist's evaluation, procedure behaviors check list (PBCL); subjective perceptions during the procedure with a questionnaire administered to children (>6 years) and their parents; drugs costs and professional resources. P-values <0.05 were considered significant. RESULTS: We had two inadequate sedations in MS (6.6%) versus 0 in GA. We had no significant differences in side effects (7.10% MS vs. 8.6% in GA), use of antagonists (2.90% GA vs. 0 MS), PBCL, oncologist evaluation and questionnaire data or drugs costs. We observed significant differences in recovery times (MS, mean 43 +/- SD min vs. GA, mean 117 +/- SD min) and professional resources costs. The effects of non-pharmacological techniques on anxiety were perceived very positively by both children and parents (on 0-4 scale, mean scores 3.57 for the children; 3.53 for the parents). CONCLUSIONS: Our study suggests that MS compared favorably to GA with respect to both safety and efficacy. When performed by non-anesthesiologists, MS may be associated with better compliance and cost-effectiveness as it relies on the contribution of non-pharmacological techniques.