Patterns of anesthesia(AS) and analgesia(AG) practice in gynecological brachytherapy in India

Fractionated HDR brachytherapy, following external beam radiotherapy, is essential for treating locally advanced cervical cancer. Modern techniques enable the delivery of multiple fractions with a single application. However, application process and removal cause significant pain and distress. With no standardized guidelines for anesthesia in gynecological brachytherapy, this study surveyed current anesthesia practices across India to better understand the variability.

A survey was conducted using an online questionnaire distributed to radiation oncologists via social media platforms (survey instrument: Rivera et al., 2024). Analysis was done using descriptive statistics.

Ninety-three responses were received, excluding 14 repeats; 79 responses were analyzed. Most of the respondents were male (52%). The most common place for intracavitary application is a dedicated brachytherapy suite. Spinal anesthesia, alone or in combination, was the most frequently used technique for intracavitary (39%), hybrid (30%), and interstitial (36%) brachytherapy. Most institutions are doing >20 applications per month. During waiting periods and treatments, oral analgesia is most commonly used. Nearly half (49%) of respondents perceived the procedure as distressing, yet fewer than half (44%) reported implementing measures to reduce psychological distress. Compared with Western data, Indian practice is characterized by higher procedure volumes, a greater reliance on regional anesthesia, and limited use of conscious sedation.

We observed clinician preference for a specific analgesic modality, highlighting clinician bias in pain control during gynecological brachytherapy. Analgesia and anesthesia during waiting times and applicator removal are areas of interest and shall be explored further. There is a need for good evidence for better management of pain and distress associated with gynecological brachytherapy.