http://www.ncbi.nlm.nih.gov/pubmed/24315253
“Trained clinical nurse specialists proficiently obtain bone marrow aspirates and trephine biopsies in a nearly painless procedure-a prospective evaluation study.”
Main point:
Properly trained nurses can performe bone marrow biopsies as well as doctors.
It does not have to hurt! 
LA & adrenaline; my clinical experience and impressions……
I don’t know if it’s the adrenaline which localizes the LA better?
I have performed about 300 BMA’s using Lidocaine with Adrenaline, 5 ml down to the periosteum, which is essential for analgesia. Before using the trocar, the site is thoroughly tested for analgesia with a probing needle to the periosteum. The vast majority(almost ‘all’) people feel very little pain upon going through the cortex into the marrow cavity.(If there is pain, we abandon, re-anaesthetise and start again).
The pain of decompression is reasonably common, but is managed well by withdrawing the BM at low negative pressure in sensitive patients; i.e. slowly.
Post procedure ache is less common when using the mechanised drill, but I feel more in control with a manual device.
Distance from skin to bone is the biggest challenge in getting an accurate and painless penetration at the LA site.
Patients rate the experience as easier then a dental appointment……..if thats anything to go by!!
Dear Robert,
Thank you for comment, I have not used adrenaline during biopsy. What is the dose of adrenaline you recommend? Do you have two drugs mixed together? or do you use separate injections?
I had my first Bone Marrow biopsy two days ago (done at Vanderbilt Med. Ctr.) by a fantastic Nurse Practioner. Along with a Nurse who was caring and calming/hardest part when trying to find the hipbone before the lidocaine (that hurt). But when lidocaine given (two shots) No Pain. You feel pressure, some tugging and a little burning but tolerable. I even forgo sedation and glad to be more awake after procedure. You have first be on your stomach; procedure took 40 mins. Then laid on back for 10 mins.; your finger is pricked for additional slides but no IV. With blood cancers you will have to have this procedure periodically as it is the best way to deem how treatments are working. Remember as we StandUp2Cancer/We will Win this Fight ! CpC