Analgesia for pelvic brachytherapy

Smith, Malcolm D.; Todd, J.G.; Symonds, R. Paul

doi:10.1093/bja/88.2.270

Cited by 38 publications

(31 citation statements)

References 37 publications

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“…Two methods have been described which avoid repeated anesthesia for serial treatments. First, an indwelling cervical sleeve can be inserted under general anesthesia during the initial treatment [3]. However, 26% of patients still experienced severe uterine pain which was relieved by nitrous oxide [8].…”

Section: Resultsmentioning

confidence: 99%

“…Second, osmotic dilators can be introduced to dilate the cervix before insertion of the applicators. Both methods are particularly useful in medically unfi t patients [3].…”

Section: Resultsmentioning

confidence: 99%

“…Cervical dilatation can be done using general, regional, or local block anesthesia. The type of anesthesia chosen depends upon the reason of the procedure as well as the medical history of the patient [3].…”

Section: Introductionmentioning

confidence: 99%

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New Technique to Avoid General Anesthesia during Brachytherapy for Cancer Cervix

Hassouna¹

2016

Int J Radiol Radiat Oncol

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Aim: To keep the cervical canal dilated after the fi rst high dose rate (HDR) brachytherapy fraction to avoid general anesthesia during subsequent applications.Patients and Methods: In the fi rst HDR brachytherapy application: examination and cervical dilatation was done under general anesthesia. The proximal 4 cm of urinary Foley catheter was cut (making the new cervical tube), inserted in the cervical canal and fi xed to the cervix by 3 simple silk sutures. Uterine tandem was inserted into the uterus through the new cervical tube and procedure was completed as usual. The new cervical tube was left in place after the end of the session. In the subsequent HDR brachytherapy applications: uterine tandem was inserted into the uterus through this new cervical tube without general anesthesia. All applications were evaluated by CT images and patients were treated according to CTimage-based 3D calculation.Results: In total: 9 HDR brachytherapy applications were done for 3 cancer cervix patients. For each patient: fi rst application was done under general anesthesia while 2 nd and 3 rd applications were done without general anesthesia (analgesia or sedation was given if needed). The uterine tandem was inserted easily and correctly with the new cervical tube in place. No complications occurred during or after the procedures.Conclusion: This is a simple new technique facilitating uterine tandem insertion without general anesthesia. Using this technique, patients can be protected from general anesthesia hazards (especially in risky patients) and time saved during brachytherapy applications. This new cervical tube is as safe and applicable as the cervical Smit sleeve; however, it is more available and cheaper. .

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Section: Resultsmentioning

confidence: 99%

“…Second, osmotic dilators can be introduced to dilate the cervix before insertion of the applicators. Both methods are particularly useful in medically unfi t patients [3].…”

Section: Resultsmentioning

confidence: 99%

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New Technique to Avoid General Anesthesia during Brachytherapy for Cancer Cervix

Hassouna¹

2016

Int J Radiol Radiat Oncol

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“…Distension of the cervix by the ovoid or ring applicator stimulates parasympathetic autonomic afferents at the S2 to S4 levels, resulting in lower back pain. Vaginal packing with gauze, a necessary step in brachytherapy to displace the bladder and rectum from the high dose region, can cause similar lower back pain [13]. Piercing of the paracervical tissue by the interstitial needles results in transmission of pain sensation via sensory and sympathetic pathways to the lateral spinothalamic tracts [14].…”

Section: Discussionmentioning

confidence: 99%

Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting

Leong

Tan

Choo

et al. 2017

jcb

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PurposeTo determine the feasibility and safety of outpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia.Material and methodsWe included patients diagnosed with non-metastatic cervix cancer and have completed brachytherapy between December 2015 and December 2016. Moderate to deep sedation was achieved using intravenous midazolam, propofol, fentanyl, and oxycodone. Local anesthesia was achieved with 2% lignocaine gel and a paracervical block containing a mixture of 1% ropivacaine, 2% lignocaine, and 1 : 1,000 adrenaline. Ceftriaxone and ondansetron were given prophylactically. Physiologic monitoring was performed throughout and pain scores were recorded using the Numeric Rating Scale. Follow-up was conducted at 8 weeks from the last fraction of brachytherapy. The feasibility and safety endpoints were a post-anesthesia discharge score (PADS) of 9 or above, and no grade 3 or above adverse events, respectively.ResultsA total of thirty-five brachytherapy insertions were carried out on nine patients. The median age of the patients was 56 years (range, 40-65). Eight patients had American Society of Anesthesiologists’ physical status of I or II, and one had a status of III. The mean duration of the insertion was 39 minutes (standard deviation [SD] = 14), during which no adverse events occurred. There was no significant nausea or vomiting post-sedation. The median pain scores post-insertion and during recovery were 0 (range, 0-6) and 0 (range, 0-7), respectively. At discharge, all patients had pain scores of 0 and maximum PADS of 10. The mean time to discharge was 4.1 hours (SD = 0.95). There were no brachytherapy-related admissions or complications.ConclusionsOutpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia is feasible and safe. This could potentially lead to significant cost savings.

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“…It is a frequently practiced procedure in countries where cervical carcinoma is very common. Though ICBT has been vastly studied and constitutes an integral portion of cervical cancer treatment, there are limited studies 7 , 10 , 11 , 12 , 13 , 14 regarding its anesthetic perspective. More so, the ICBT anesthesia studies have dealt with the efficacy and the toxicity aspect, but rarely with dosimetric perspective.…”

Section: Discussionmentioning

confidence: 99%

Comparison of high‐dose‐rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma

Sharma

Chaudhari

Sharma

et al. 2014

J Applied Clin Med Phys

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This study compares the dosimetry of high‐dose‐rate intracavitary brachytherapy (HDR‐ICBT) performed with and without general anesthesia/spinal anesthesia (GA/SA) in patients with cervical carcinoma. We retrospectively retrieved the records of 138 HDR‐ICBT applicator insertions performed in 46 patients: 69 performed with GA/SA (anesthesia group known as AG) in 23 patients, and 69 performed without GA/SA (nonanesthesia group known as NAG) in 23 patients. The intracavitary brachytherapy (ICBT) application was done with central tandem and two vaginal ovoids. For each ICBT plan, a high‐dose‐rate (HDR) dose of 7 Gy was prescribed to point A. From each plan, the doses to Point B right false(normalBRfalse), Point B left false(normalBLfalse), bladder and rectal reference points (Bladderref and Rectalref) were recorded and compared in the two groups. Student's t‐test was applied to find out the significance of difference. The two groups were comparable in terms of demography and clinical characteristics. Mean Point BL doses in AG and NAG were 1.89 Gy (27% of Point A dose) and 1.82 Gy (26% of Point A dose), respectively. Mean Point BR doses in AG and NAG were 1.91 Gy (27% of Point A dose) and 1.85 Gy (26% of point A), respectively (p‐value 0.7). The mean dose to Bladderref in AG and NAG was 5.03 Gy and 4.90 Gy, respectively (p‐value 0.6). The mean dose to Rectalref was significantly higher in AG than NAG (5.09 Gy vs. 4.49 Gy, p‐value 0.01). Although based on conventional 2D dosimetry planning, our study has demonstrated that avoiding GA/SA does not result in inferior HDR‐ICBT dosimetry.PACS number: 87.53.Jw, 87.50.cm

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Analgesia for pelvic brachytherapy

Cited by 38 publications

References 37 publications

New Technique to Avoid General Anesthesia during Brachytherapy for Cancer Cervix

New Technique to Avoid General Anesthesia during Brachytherapy for Cancer Cervix

Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting

Comparison of high‐dose‐rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma

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