A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which?
a. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
b. Use a combination of fentanyl and midazolam for conscious sedation.
c. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
d. Apply a transdermal fentanyl (Duragesic) "patch" immediately before the procedure.
ANS: B
A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.
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