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

Clarke, Hance A.; Tarshis, Jordan; Lam-McCulloch, Jenny; Kay, Joseph

doi:10.1016/j.brachy.2009.01.005

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Volume 8, Issue 4 , Pages 335-338, October 2009

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

Hance A. Clarke
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
- Corresponding author. Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Eaton North 3 EB 317, Acute Pain Research Unit, Toronto, ON M5G 2C4, Canada. Tel.: +1-416-340-4800 ext 6649; fax: +1-416-340-3698.
Jordan Tarshis
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
Jenny Lam-McCulloch
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Joseph Kay
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada

Received 3 December 2008; received in revised form 21 January 2009; accepted 26 January 2009. published online 12 May 2009.

Abstract

Purpose

To determine effective spinal anesthetic dosing of hyperbaric bupivacaine for patients undergoing high-dose-rate (HDR) brachytherapy for prostate cancer.

Methods

A total of 199 HDR prostate brachytherapy sessions (n=115 patients) under spinal anesthesia with five doses of hyperbaric bupivacaine were prospectively analyzed. Patients received either 11.25mg (n=40 sessions), 15mg (n=63 sessions), 18mg (n=25 sessions), 18.75mg (n=17 sessions), or 20.25mg (n=54 sessions) of 0.75% of bupivacaine with 20μg of fentanyl in 8.25% of dextrose (Hospira, Healthcare Corporation, Montréal, Canada). Sensory block level, intraoperative hypotension, incidence of nausea and vomiting, time to ambulation, and time to discharge were recorded. We assessed for the presence of any transient neurologic symptoms post discharge.

Results

The 11.25-mg group had a mean peak sensory block height of L1 at 90min, which was significantly lower than the other groups. Block heights were also decreased at the 5, 60, 120, 150, 180, and 300min time points (p<0.05). The mean time to ambulation was 403±92min and to discharge was 427±70min; no difference among groups was found. Hypotension was not observed in the 11.25-mg group, whereas the incidence of operative hypotension was 8% in each of the other groups. No transient neurologic symptoms were reported postoperatively.

Conclusions

The 11.25-mg dose of hyperbaric bupivacaine was sufficient to provide intraoperative anesthesia for catheter placement and sufficient postoperative residual analgesia for the duration that the catheters were left in situ and subsequently removed.

Keywords: Analgesia, Brachytherapy, Dose response, Pain, Regional anesthesia, Saddle block