• Yoko Kato, Miho Maeda, Yuki Aoki, Eizaburo Ishii, Ysushi Ishida, Chikako Kiyotani, Shoko Goto, Sachi Sakaguchi, Kenichi Sugita, Mika Tokuyama, Hisaya Nakadate, Akira Kikuchi, Masahiro Tsuchida, and Akira Ohara.
• Tokyo Children's Cancer Study Group, Quality of Life Committee, Tokyo; Department of Pediatrics, Jikei University School of Medicine, Tokyo.
• Pediatr Int. 2014 Jun 1; 56 (3): 354-9.

BackgroundThe pain associated with bone marrow aspiration and biopsy (BMAB) has an enormous impact on pediatric cancer patients and their families, but no specific reference standards for sedation and analgesia have been developed in Japan. To determine the problems associated with pain management during BMAB, a cross-sectional investigation was conducted.MethodsA survey was sent in October 2011 to data managers in institutions belonging to the Tokyo Children's Cancer Study Group, addressing the non-pharmacological and pharmacological pain management for BMAB performed on pediatric cancer inpatients between January 2010 and December 2010.ResultsThe eligible response rate was 41 of 57 institutions (71.9%). Non-pharmacological pain intervention was provided in 68% of surveyed institutions. All institutions provided pharmacological pain management. In most institutions, sedation/analgesia was performed by pediatric oncologists in a treatment room in the ward. Standards for pain management were developed and utilized in only four institutions. Other means of pain management were provided in various settings. Twelve institutions reported insufficient sedation/analgesia. In total, 80% of institutions reported some adverse events. Two serious adverse events were reported in cases of underlying or complicated conditions. No serious long-term consequences were reported.ConclusionsSignificant issues were identified regarding the efficacy and safety of pain management. Adverse events can occur in any institution. Children with underlying or complicated conditions are at high risk for serious adverse events. Therefore, adequate and systematic assessment, patient monitoring, preparation and treatment for adverse events, and cooperation with skilled specialists of pediatric oncology, anesthesiology, and intensive care are essential.© 2014 Japan Pediatric Society.

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