Anaesthesia for brachytherapy

The demand for anaesthesia in brachytherapy is increasing. Patients often present with high-risk factors and multiple comorbidities. To achieve a stable position of the implants, immobility is often mandatory. Duration of brachytherapy varies greatly and may exceed the duration of single-shot regional anaesthesia. Transportation of anaesthetized patients is a typical challenge. This review gives information about anaesthesia techniques in brachytherapy on the basis of the literature and the authors' experiences.

The choice of anaesthesia technique depends on the body region, the type of brachytherapy and the local infrastructure. Topical or local anaesthesia is used by radiotherapists. For brachytherapy of the lower body, regional anaesthesia provides effective and safe conditions. Catheter techniques are used for longer procedures and for high-risk patients, allowing excellent ongoing epidural patient-controlled analgesia. General anaesthesia is safely utilized for brachytherapy of the upper body or as an alternative to regional techniques. However, the effort under the typical conditions of the brachytherapy setting may be higher. Sedation is regarded as an alternative to general anaesthesia in less painful and short procedures.

In conclusion, anaesthesiologists play a key role in the ongoing challenge to provide safe and pain-free conditions for an optimum brachytherapy treatment effect.