Actiq Useful in Adults Undergoing Bone Marrow Biopsy

NEW ORLEANS—Primarily used for preprocedural analgesia and sedation in children, oral transmucosal fentanyl citrate (Actiq) also works well for adult cancer patients undergoing diagnostic bone marrow aspiration and biopsy, Cheryl Ann Arena, MPH, PA–C, said at her poster presentation at the American Society of Hematology annual meeting.

“This medication not only helps alleviate the patient’s pain but also takes care of the patient’s anxiety,” said Ms. Arena, of the Department of Molecular Hematology and Therapy, M.D. Anderson Cancer Center.

The lozenge-on-a-handle design of Actiq allows quick absorption of the medication. “This allows us to get patients out of the clinic more quickly,” she said.

Ms. Arena and her M.D. Anderson co-authors investigated Actiq in a small nonblinded prospective study of 30 cancer patients. All were to undergo diagnostic bone marrow aspiration or biopsy and had requested premedication. Each was given 200 µg of Actiq 30 minutes before the procedure.

Of the 26 patients whose results were evaluable, 12 reported relaxation or reduction of anxiety after this dose. The other 14 received a second 200-µg dose.

Pain Scores Reduced

Patients answered questionnaires before and after bone marrow aspiration or biopsy, rating their pain, comparing this procedure with previous ones, and listing side effects.

Current pain scores were significantly lower than past pain scores. On a pain scale of 0 (no pain) to 5 (worst pain imaginable), patients who received 200 µg of Actiq scored the current procedure 1.75, compared to 3.0 for previous procedures. Those who received 400 µg, scored the current procedure 1.59, compared to 3.97 for previous procedures. The previous procedures were sometimes conducted with analgesics, sometimes without.

Nine patients had been premedicated during previous bone marrow procedures. Four patients rated Actiq as better than their previous premedication—Demerol (meperidine hydrochloride), Valium (diazepam), or Demerol plus Versed (midazolam hydrochloride). Three patients rated Actiq just as effective as their previous medications—Xanax (alprazolam), Demerol plus Versed, or Demerol plus Ativan (lorazepam).

Side effects occurred in eight patients and lasted an average of 1 hour. The most common side effects were somnolence (36%), nausea (14%), dizziness (14%), and dry mouth (7%). One patient had a bout of vomiting and nausea that started 6 hours after receiving Actiq and lasted for another 6 hours. This patient had recently undergone chemotherapy.

Most patients (20 of 24 who responded) said they wanted to have Actiq again for their next procedure. Two patients were undecided, and two did not want to have Actiq again because of side effects or ineffectiveness.

The researchers concluded that “oral transmucosal fentanyl citrate can be effectively used as preprocedure analgesia for bone marrow aspiration and biopsy with minimal side effects in cancer patients.”