Saddle block analgesia for high-dose-rate brachytherapy: A prospective study

Area of Science:

• Anesthesiology
• Oncology

Background:

• High-dose-rate (HDR) brachytherapy for prostate cancer requires effective anesthesia.
• Spinal anesthesia with hyperbaric bupivacaine is a common choice.

Purpose of the Study:

• To determine the optimal spinal anesthetic dose of hyperbaric bupivacaine for HDR prostate brachytherapy.
• To evaluate the efficacy and safety of different bupivacaine doses.

Main Methods:

• Prospective analysis of 199 HDR prostate brachytherapy sessions under spinal anesthesia.
• Five doses of hyperbaric bupivacaine (11.25mg to 20.25mg) with fentanyl were administered.
• Key outcomes included sensory block level, hypotension, nausea/vomiting, ambulation, discharge times, and transient neurologic symptoms.

Main Results:

• The 11.25mg bupivacaine dose resulted in a significantly lower peak sensory block height (L1) compared to higher doses.
• No intraoperative hypotension was observed with the 11.25mg dose, unlike the 8% incidence in higher dose groups.
• Mean ambulation (403±92 min) and discharge (427±70 min) times did not differ significantly across groups.

Conclusions:

• 11.25mg of hyperbaric bupivacaine is sufficient for intraoperative anesthesia during HDR prostate brachytherapy catheter placement.
• This dose provides adequate postoperative analgesia for the duration of catheter indwelling.
• The 11.25mg dose is associated with a lower incidence of intraoperative hypotension.