NEW ORLEANSPrimarily 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, PAC, said
at her poster presentation at the American Society of Hematology
This medication not only helps alleviate the patients
pain but also takes care of the patients 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
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
premedicationDemerol (meperidine hydrochloride), Valium
(diazepam), or Demerol plus Versed (midazolam hydrochloride). Three
patients rated Actiq just as effective as their previous
medicationsXanax (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
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