Famous Among Top Surgeons in the 90s

Where is the pain from a bone marrow aspiration.

Generally, punctures cause pain when the needle passes through the skin, that’s the first point. Secondly, the nerves in the bone are mainly distributed on the periosteum, so when the needle punctures the periosteum, the patient will inevitably feel pain. For these two, before the procedure, when the doctor administers local anesthesia to the patient, injecting the anesthetic into the skin and periosteum can resolve these pain issues. The third type of pain is unresolvable, it’s the kind that occurs when the needle enters the bone marrow cavity and creates negative pressure while extracting the bone marrow. At this time, to reduce the patient’s pain, the doctor needs to extract more slowly.

How much to extract depends on the specific case. Some cases allow for extracting one milliliter to obtain bone marrow, while others may not. Simple bone marrow smears don’t require much extraction. If additional tests like gene cultivation are needed, a larger amount must be extracted using bigger syringes, even up to 20 milliliters.

The assistant stands opposite the doctor responsible for the puncture, helping observe the pediatric patient’s condition, assisting, and helping prepare the bone marrow smear. The bone marrow smear involves dropping the drawn bone marrow onto a glass slide, somewhat similar to the plant leaf slides in high school biology class. For today’s pediatric patient initial diagnosis, more than five slides need to be prepared.

Doctor Tian said to the students, "Bone marrow aspiration has relatively lower risk compared to other puncture procedures, there’s no need to be nervous."

Teacher’s words can be understood this way. Extracting bone marrow definitely involves targeting large bones in the body. The target bone is large, not like deep vein puncture which requires precise targeting of deep, thin, and slippery blood vessels akin to a blind person touching an elephant. The difficulty and risk of lumbar puncture have been mentioned before, as extracting cerebrospinal fluid carelessly can affect the patient’s brain.

For bone marrow aspiration, the bone can be felt through the skin, making it easy to target with one needle, leading to low error probability and low risk of complications. Additionally, bone marrow aspiration offers many target options for the doctor. If one bone isn’t suitable or can’t yield extraction, another bone can be targeted.

Typically, clinically, bone marrow can be aspirated from the sternum, iliac bone, and tibia. The iliac bone is the best target for a puncture, it has a large marrow cavity with abundant bone marrow for easy extraction. For children under six months old, the tibia is most often extracted from, as the tibia’s puncture site is relatively the safest.

Considering the high risk of sternum puncture, for safety, and with family members present, doctors hesitate to take the risk with the sternum and opt for the iliac bone, the favored choice. The entry point can be chosen at the anterior superior iliac spine or the posterior superior iliac spine.

Zhang Desheng has previously interned at Guoxie’s hematology department, has seen teachers perform bone marrow aspiration, and assisted teachers, making him chosen by Teacher Tian for the procedure. Zhao Zhaowei assists on the side.

Several surgical students who haven’t been to Guoxie’s hematology department observe from the side. What’s special is Student Xie, named by the pediatric patient’s family to care for the child, stands by the puncture doctor to help hold the child.

In any puncture operation, accurately locating the anatomical position of the puncture target is paramount.

Zhang Desheng’s gloved fingers feel on the child’s iliac bone while using a questioning eye gesture to ask Student Xie: Is this location right, Yingying?

It’s well-known that Student Xie is a super scholar in anatomic positioning. Classmates who are smart seize the opportunity to ask Student Xie for advice.

The child is positioned supine, Xie Wanying deduces the classmate might want to enter from the anterior superior iliac spine, says: If you’re not too confident in the puncture, choosing the posterior superior iliac spine is better. The posterior superior iliac spine has a bigger bone plane compared to the anterior superior iliac spine, making it easier to puncture. If you fear the posterior superior iliac spine makes the child’s position hard to hold, we’ll assist in stabilizing it.

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