Repeated procedures like lumbar puncture and bone marrow aspiration are routine part of management of several childhood cancers (in particular acute lymphoblastic leukaemia). Adequate sedation and analgesia for these procedures in a safe environment is desirable and there are guidelines available in Europe and North America in this context. The mainstay of sedation in such settings is general anaesthesia.
A recent survey shows that the practice of sedation and analgesia for lumbar punctures and bone marrow aspiration in children with cancer in India is varied and includes no sedation/analgesia, local anaesthesia or some systemic sedation/analgesia but no general anaesthesia (unpublished data). Further research is needed to identify reasons for these variations.
The recently published report from Vietnam (in collaboration with Swedish investigators) shows reduced pain and anxiety in children aged 7-12 years with leukaemia during and after lumbar puncture who were randomised to receive music therapy compared to no music. (Ref - Nguyen et al, Journal of Pediatric Oncology Nursing, May-June 2010). What makes this clinical trial particularly relevant to the Indian context is the fact that besides music therapy, there was no use of any form of sedation/analgesia for the procedure. Such a practice of lack of any sedation/analgesia during the procedure is standard in Vietnam and also a common occurrence in India. Music therapy is a low cost, safe and easily available option which should be considered (in isolation or as an adjunct) for these procedures.