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Becerra-Bolaños Á, Jiménez-Gil M, Federico M, Domínguez-Díaz Y, Valencia L, Rodríguez-Pérez A. Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study. J Pers Med 2023; 13:1187. [PMID: 37623438 PMCID: PMC10456084 DOI: 10.3390/jpm13081187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.
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Affiliation(s)
- Ángel Becerra-Bolaños
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
| | - Miriam Jiménez-Gil
- Department of Anesthesiology, Complejo Hospitalario Universitario Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain;
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Yurena Domínguez-Díaz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Lucía Valencia
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
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Kumar V, Gulia A, Garg R, Gupta N, Bharati SJ, Mishra S, Bhatnagar S. Perioperative anesthesia management for brachytherapy in cancer patients: A retrospective observational study. J Anaesthesiol Clin Pharmacol 2021; 37:598-603. [PMID: 35340946 PMCID: PMC8944377 DOI: 10.4103/joacp.joacp_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 09/17/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Anesthetic management for brachytherapy require repeated exposure to anesthesia in elderly patients with comorbidities. The varying locations provide an anesthesiologist with further challenges. MATERIAL AND METHODS We studied retrospectively anesthesia type, details of anesthetic techniques and complications that occurred in patients having received anesthesia for brachytherapy in our institute in the last 6 years. Categorical variables were described as frequency and percentage, and continuous variables described as median and interquartile range. For continuous variables, mean values compared using two sample t tests for independent samples. RESULTS The majority of patients were females who received brachytherapy for carcinoma cervix. A higher percentage of carcinoma breast and male genitourinary malignancies had comorbidities. Predominant side effects included 22 (1.85%) had hypotension, 19 (1.59%) had difficulty in putting spinal, 13 (1.09%) patients had tachycardia and 11 (0.92%) had headache in the postoperative period. CONCLUSION Neuraxial block as anesthetic technique in pelvic brachytherapy using fentanyl as additive helped reduce the dose of local anesthetic and avoided the complications of high spinal. The choice of anesthesia can vary depending on the duration and site of brachytherapy keeping in consideration the patient's factors.
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Affiliation(s)
- Vinod Kumar
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
- Address for correspondence: Dr. Vinod Kumar, Room No. 139, Dr BRAIRCH, AIIMS, Ansari Nagar, Delhi - 110 029, India. E-mail:
| | - Abhity Gulia
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | - Rakesh Garg
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | - Nishkarsh Gupta
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | | | - Seema Mishra
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | - Sushma Bhatnagar
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
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Kumar V, Ahuja D, Gupta N, Bharati SJ, Garg R, Mishra S, Haresh KP, Gupta S, Bhatnagar S. Anesthesia concerns in prostate brachytherapy: An institutional experience. Indian J Cancer 2020; 57:411-415. [PMID: 33078747 DOI: 10.4103/ijc.ijc_666_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prostate cancer is a common cancer found in men worldwide. Brachytherapy is an established modality used for the treatment of these patients. Although anesthetic management of such patients is challenging but the ideal anesthetic technique has not yet been established. Our study aims to identify the most efficacious anesthetic technique for perioperative management of prostate cancer patients undergoing brachytherapy. METHODS Retrospective analysis of ten patients who underwent 16 brachytherapy sessions under combined spinal epidural (CSE) anesthesia between April 2016 and December 2016 was done. The data were collected, tabulated using MS Excel, and statistically analyzed with EPI Info 6 and SPSS-16 statistical software (SPSS Inc. Chicago, USA) to draw relative conclusions. RESULTS The median peak sensory dermatome level achieved was T6 and the median maximum motor block achieved was grade 2. The mean (± standard deviation (SD)) time to sensory regression to T10 (range T5-T8) dermatome was found to be 118.00 ± 47.110 (range = 0-238) minutes. Despite the presence of co-morbidities, minor intraoperative complications were observed only in two patients. The postoperative numerical rating scale (NRS) was less than 4 in all patients during the first 24 hours. None of our patients complained of nausea, vomiting, pruritus and respiratory depression. The mean (± SD) patient satisfaction score was 44.40 ± 0.871 (range : 1-5) at the end of 24 hours. CONCLUSIONS CSE anesthesia is a safe and effective technique for anesthetic management of patients undergoing prostate brachytherapy.
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Affiliation(s)
- Vinod Kumar
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Ahuja
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand J Bharati
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - K P Haresh
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Radiotherapy, New Delhi, India
| | - Subhash Gupta
- Department of Radiotherapy, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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Gourkanti B, Mulvihill D, Kalariya J, Li Y. Radiotherapy and Anesthesia. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Weatherall AD, Bennett TR, Lovell M, Fung W, de Lima J. Staged intraperitoneal brachytherapy and hyperthermic intraperitoneal chemotherapy in an adolescent: novel anesthetic challenges for pediatric anesthetists. Paediatr Anaesth 2017; 27:338-345. [PMID: 28211128 DOI: 10.1111/pan.13094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 12/13/2022]
Abstract
Newer techniques that have found a place in cancer management in adults are offered far less commonly in pediatric patients. We present a case of a patient with recurrent Wilms' tumor managed with a novel combination of cytoreductive surgery, intraperitoneal brachytherapy, and subsequent hyperthermic intraperitoneal chemotherapy. Each stage presents challenges that the pediatric anesthetist is unlikely to have faced before. Such cases require flexibility and thorough planning to manage the combination of major surgery, remote anesthesia with brachytherapy and hyperthermic chemotherapy with its potential for metabolic derangement, significant fluid shifts, analgesic care, and potential exposure of staff to cytotoxic agents. Comprehensive care can be offered in pediatric centers.
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Affiliation(s)
- Andrew D Weatherall
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia
| | - Tristan R Bennett
- Department of Anaesthesia, Middlemore Hospital, Auckland, New Zealand
| | - Mark Lovell
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia
| | - Winnie Fung
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia
| | - Jonathan de Lima
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, Australia
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Amsbaugh AK, Amsbaugh MJ, El-Ghamry MN, Derhake BM. Optimal epidural analgesia for patients diagnosed as having gynecologic cancer undergoing interstitial brachytherapy. J Clin Anesth 2016; 35:509-515. [DOI: 10.1016/j.jclinane.2016.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
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Sharma DN, Chaudhari P, Sharma S, Gupta L, Jagadesan P, Rath GK, Julka PK. Comparison of high-dose-rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma. J Appl Clin Med Phys 2014; 15:4670. [PMID: 24710456 PMCID: PMC5875476 DOI: 10.1120/jacmp.v15i2.4670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/03/2013] [Accepted: 10/30/2013] [Indexed: 11/30/2022] Open
Abstract
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 (BR), Point B left (BL), 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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9
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Anaesthetic techniques for unique cancer surgery procedures. Best Pract Res Clin Anaesthesiol 2013; 27:513-26. [DOI: 10.1016/j.bpa.2013.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
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Bhanabhai H, Samant R, E C, Grenier L, Lowry S. Pain assessment during conscious sedation for cervical cancer high-dose-rate brachytherapy. ACTA ACUST UNITED AC 2013; 20:e307-10. [PMID: 23904769 DOI: 10.3747/co.20.1404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This observational study set out to evaluate the effectiveness of conscious sedation anesthesia for pain control during high-dose-rate (hdr) brachytherapy using a ring-and-tandem applicator system for patients with cervical cancer. METHODS At the time of initiation of the hdr cervical cancer brachytherapy program at our institution, patients received a detailed symptom assessment during the procedures. Brachytherapy was carried out using a Smit sleeve, together with a ring-and-tandem applicator. Midazolam and an opioid-hydromorphone, morphine, or fentanyl-were the main agents used to achieve conscious sedation. RESULTS From January 2009 to October 2010, 20 patients (median age: 45 years) underwent 57 procedures. All patients received chemoradiation with curative intent. The median duration of the procedures was 1.4 hours, and no significant cardiovascular events were noted. The total dose of intravenous midazolam used ranged from 0.5 mg to 8.5 mg (median: 2.5 mg). The total dose of intravenous morphine equivalent used ranged from 2.5 mg to 60 mg (median: 8 mg). The mean and median pain scores during the procedures were 1.4 and 1.1 respectively. Brief moments of moderate to severe incidental pain were noted at the time of certain events during the procedure-specifically during insertion of the ring-and-tandem applicator. The maximal pain score during the entire procedure ranged from 0 to 10 (median: 4.7). The period of recovery from conscious sedation was relatively brief (median discharge time: 1 hour). CONCLUSIONS We were able to demonstrate that patients undergoing hdr brachytherapy for cervical cancer can achieve good pain control with conscious sedation.
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Affiliation(s)
- H Bhanabhai
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
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Does multimodal analgesia premedication improve the management of carcinoma cervix brachytherapy? Pain Res Manag 2012; 17:353-4. [PMID: 23061087 DOI: 10.1155/2012/154875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Maani CV, Shah MA, Hansen JJ, Fowler M, Maani EV, McGhee LL. Translational advances in pain and anesthesia for cancer patients. J Surg Oncol 2012; 105:488-93. [PMID: 22441901 DOI: 10.1002/jso.21853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Effective cancer pain management requires multidisciplinary approaches for multimodal analgesia. Although opioids have been the cornerstone, developments such as regional anesthesia and interventional pain techniques, complementary and alternative medicine, and new pharmaceuticals also have shown promise to relieve cancer pain. This overview of relevant clinical efforts and the modern day state of the science will afford a better understanding of pain mechanisms and multimodal approaches beneficial in optimizing analgesia for cancer patients.
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Affiliation(s)
- Christopher V Maani
- Department of Anesthesia, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
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