Pain Management Following Intracavitary Brachytherapy Procedures: A Prospective, Randomized, Double-Blind Study

Background and objectives Intracavitary applicators are a source of significant discomfort after brachytherapy procedures while undergoing subsequent radiation treatment. With strides towards opioid-sparing anesthesia and analgesia, it's essential to find appropriate substitutes. This procedure requires adequate relaxation of pelvic muscles during the procedure and proper analgesia after the procedure, with the presence of intracavitary applicators, needed for radiation treatment. We studied the day-case safety and analgesic efficacy of adjuvants dexmedetomidine 3 µg and fentanyl 15 µg intrathecally to low-dose 0.5% hyperbaric bupivacaine. Methods Seventy females scheduled for brachytherapy procedures were randomly allocated to receive either Group I (0.5% hyperbaric bupivacaine (1.8 ml) plus 3µg dexmedetomidine (0.3ml)) or Group II (0.5% hyperbaric bupivacaine (1.8 ml) plus 15µg fentanyl (0.3ml)). The primary outcome was to assess and compare the brachytherapy (day-case) feasibility with 3µg dexmedetomidine and 15µg fentanyl (time taken to meet hospital discharge criteria). The secondary outcomes were the absolute duration of spinal analgesia, pain scores, patient satisfaction scores, and any associated adverse events. Data analysis was done using IBM SPSS software for Windows, version 21.0 (IBM Corp., Armonk, NY). Results All patients in Group I were discharged on the same day without any adverse effects. They underwent an intracavitary brachytherapy procedure under spinal anesthesia with stable hemodynamics successfully. The mean time taken to meet hospital discharge criteria in Group II was shorter than in Group I (258.43 ± 27.460 vs. 335.71 ± 21.114). The mean absolute duration of spinal analgesia was significantly longer in Group I as compared to Group II (406.82 ± 51.78 mins vs. 267 ± 16.23 mins) (p<.001). Seventeen patients required rescue analgesia in Group II versus eight in Group I (p<0.025). Conclusion Patients in both groups received excellent analgesia with enhanced patient satisfaction. Three µg intrathecal dexmedetomidine as an adjuvant to low-dose hyperbaric bupivacaine can be used safely in day-case brachytherapy procedures. It provides adequate anesthesia and prolonged spinal analgesia as compared to 15 µg fentanyl.