Efficacy of Acetaminophen-Promethazine Versus Parenteral Pethidine-Midazolam for Bone Marrow Sampling Pain Control: Randomized Clinical Trial

A bone marrow examination is necessary to diagnose some hematologic diseases. In this study, we compared the effects of acetaminophen and promethazine versus intravenous injections of midazolam and pethidine on pain reduction after bone marrow sampling.

In this study, 88 patients were divided into two groups. The first received one gram of acetaminophen as an infusion and 25 milligrams of promethazine syrup 30 minutes before the procedure. The second group received intravenous injections of 25 milligrams of pethidine and 5 milligrams of midazolam five minutes before the procedure. In two groups, local anesthesia with lidocaine was given before the procedure. The pain and presence of anxiety in the patients were assessed using a 10-point Likert scale.

We analyzed the results of 88 patients. At 30 minutes after sampling, patients in the pethidine-midazolam group reported lower pain compared to those in the promethazine-acetaminophen group (1.18±0.90 vs. 1.77±0.99) (P=0.004). This difference was particularly notable among men (0.90±0.98 vs. 0.99±1.67) (P=0.001). Among men, those older than 30 years showed a reduction in pain (1.01±0.9 vs. 0.99±1.46) (P=0.049). No significant difference was observed between the two groups in terms of pain immediately after sampling. The administration of promethazine and acetaminophen showed a more positive future perspective in patients older than 46 years (P=0.033). Additionally, the average incidence of anxiety 30 minutes after the procedure was 27.3% in the pethidine-midazolam group and 22.7% in the promethazine-acetaminophen group. However, there was no significant difference in the level of anxiety between the two groups (P=0.806).

Based on our data, the combination of promethazine and acetaminophen had similar analgesic effects to the combination of pethidine and midazolam immediately after sampling. As a result, according to the various side effects of pethidine and midazolam, especially in patients with respiratory diseases and outpatients, the combination of promethazine and acetaminophen can be used.