• To study pain control during and after procedures such as bone marrow aspiration and lumbar puncture with intrathecal chemotherapy by using a combination of EMLA or L.M.X4™ cream, the analgesic drug fentanyl, and the anesthetic drug propofol [ Time Frame: Until time of discharge from the recovery room followed by a phone evaluation within 7 days. ] [ Designated as safety issue: Yes ]
• To study and determine which combinations of fentanyl, propofol, and EMLA or L.M.X4™ achieve the best pain control for these procedures [ Time Frame: Until time of discharge from the recovery room followed by a phone evaluation within 7 days. ] [ Designated as safety issue: Yes ]

• To study pain control during and after procedures such as bone marrow aspiration and lumbar puncture with intrathecal chemotherapy by using a combination of EMLA or L•M•X4™ cream, the analgesic drug Fentanyl, and the anesthetic drug Propofol.
• To study and determine which combinations of Fentanyl, Propofol, and EMLA or L•M•X4™ achieve the best pain control for these procedures.

St. Jude Children's Research Hospital is studying the best ways to prevent pain during and after procedures such as bone marrow aspiration and lumbar puncture with intrathecal (in the spinal fluid) chemotherapy. Researchers will study the effectiveness of combining anesthetics (medicines that help people sleep) and analgesics (medicines that relieve pain). Researchers believe that a combination of fentanyl (analgesic) and propofol (anesthetic), along with applying the skin-numbing-cream EMLA or L.M.X4™ on the area where the procedure is performed, will provide better pain control.

Each patient enrolled on this study will have three different anesthetic combinations for three different procedures, in order to determine which combination worked best for each child.

• Bone Marrow Disease
• Pain

• Drug: Fentanyl
• Drug: EMLA
• Drug: L.M.X4
• Drug: Propofol

• Active Comparator: Fentanyl-1mcg/kg in 3 ml of Normal Saline
• Active Comparator: Fentanyl - 0.5 mcg/kg in 3 ml normal saline
• Placebo Comparator: normal saline

Inclusion Criteria:

• Age: 2-17 years old.
• Subjects undergoing bone marrow aspiration (unilateral) with lumbar puncture and intrathecal chemotherapy.
• Subjects with acute lymphoblastic leukemia or lymphoblastic lymphoma in remission or are having anticipated remission procedures occurring at the end of remission induction.