Wallner Kent
Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA, USA.
Brachytherapy. 2002;1(3):145-8. doi: 10.1016/s1538-4721(02)00053-3.
Local anesthesia for prostate brachytherapy was instituted at the Puget Sound Veterans Hospital in 1999, peforming the procedure in our own department without anesthesia personnel in attendance.
The patient is brought into the simulator suite in the radiation oncology department, an i.v. line is started, a cardiac monitor attached, and a urinary catheter is inserted. He is then placed in the lithotomy position, using stirrups attached to the simulator table. A 6-8 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 1% lidocaine. The transrectal ultrasound (TRUS) probe is then inserted and positioned to reproduce the planning images. A 3.0 inch 22-gauge spinal needle is used to inject lidocaine up to the prostatic apex, in a pattern around the periphery of the prostate. Once the pelvic floor and prostatic apex are anesthetized, a 7.0-inch, 22-gauge spinal needle is inserted through an 18-gauge 3 inch spinal needle into the peripheral planned needle tracks, monitored by TRUS. As the needles are advanced to the prostatic base, about 1.0 cc of lidocaine solution is injected in the intraprostatic track. A total of 200 to 500 mg of lidocaine is used.
As of December 2000, more than 600 patients have received implants under local anesthesia at Seattle, WA. Patients tolerate brachytherapy under local anesthesia surprisingly well. Post-implant CT-defined target coverage has ranged from 80% to 95%, well within published criteria for technical adequacy. Patients' typical implant pain score is 3, on a scale of 0-10. After a series of patient acceptance quality studies, we have abandoned the routine use of sedation, and relied instead on local lidocaine infiltration alone.
In addition to a high degree of patient satisfaction, performing implants under local anesthesia allows for phenomenal logistical efficiencies and cost advantages.
1999年普吉特海湾退伍军人医院开始采用局部麻醉进行前列腺近距离放射治疗，在我们自己的科室进行该手术时无需麻醉人员在场。
患者被带入放射肿瘤科的模拟室，建立静脉通路，连接心脏监护仪，并插入导尿管。然后让患者处于截石位，使用连接在模拟台上的马镫。通过局部浸润1%利多卡因对6 - 8厘米的会阴皮肤和皮下组织进行麻醉。然后插入经直肠超声（TRUS）探头并定位以重现计划图像。使用一根3.0英寸的22号脊麻针围绕前列腺周边向前列腺尖部注射利多卡因。一旦盆底和前列腺尖部被麻醉，将一根7.0英寸的22号脊麻针通过一根18号3英寸的脊麻针插入预先规划的外周针道，由TRUS监测。当针推进到前列腺底部时，在前列腺内针道注射约1.0毫升利多卡因溶液。总共使用200至500毫克利多卡因。
截至2000年12月，华盛顿州西雅图市已有600多名患者在局部麻醉下接受了植入治疗。患者在局部麻醉下对近距离放射治疗的耐受性出奇地好。植入后CT定义的靶区覆盖范围为80%至95%，完全符合已公布的技术适当性标准。患者植入后的典型疼痛评分为3分（0 - 10分制）。经过一系列患者接受度质量研究后，我们已不再常规使用镇静剂，而是仅依靠局部利多卡因浸润。
除了患者满意度高之外，在局部麻醉下进行植入治疗还具有显著的后勤效率和成本优势。
