Sharma Jagdeep, Walia Harsimran, Mitra Lalita G
Anaesthesia, Critical Care, and Pain Medicine, Homi Bhabha Cancer Hospital and Research Centre, New Chandigarh, IND.
Anaesthesia, Critical Care, and Pain Medicine, Homi Bhabha Cancer Hospital and Research Center, New Chandigarh, IND.
Cureus. 2024 Aug 24;16(8):e67681. doi: 10.7759/cureus.67681. eCollection 2024 Aug.
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.
腔内施源器是近距离放射治疗后接受后续放疗过程中显著不适的来源。随着向减少阿片类药物使用的麻醉和镇痛方向发展，找到合适的替代药物至关重要。该操作在治疗过程中需要盆腔肌肉充分放松，治疗后需要适当镇痛，同时放疗需要腔内施源器的存在。我们研究了鞘内注射右美托咪定3μg和芬太尼15μg作为低剂量0.5%高压布比卡因辅助药物的日间手术安全性和镇痛效果。方法：70名计划接受近距离放射治疗的女性被随机分配接受I组（0.5%高压布比卡因（1.8ml）加3μg右美托咪定（0.3ml））或II组（0.5%高压布比卡因（1.8ml）加15μg芬太尼（0.3ml））。主要结局是评估和比较3μg右美托咪定和15μg芬太尼用于近距离放射治疗（日间手术）的可行性（达到出院标准所需时间）。次要结局是脊髓镇痛的绝对持续时间、疼痛评分、患者满意度评分以及任何相关不良事件。使用IBM SPSS for Windows 21.0软件（IBM公司，纽约州阿蒙克）进行数据分析。结果：I组所有患者均在同一天出院，无任何不良反应。他们在脊髓麻醉下成功进行了腔内近距离放射治疗，血流动力学稳定。II组达到出院标准的平均时间短于I组（258.43±27.460对335.71±21.114）。I组脊髓镇痛的平均绝对持续时间显著长于II组（406.82±51.78分钟对267±16.23分钟）（p<0.001）。II组有17名患者需要补救镇痛，而I组为8名（p<0.025）。结论：两组患者均获得了良好的镇痛效果，患者满意度提高。鞘内注射3μg右美托咪定作为低剂量高压布比卡因的辅助药物可安全用于日间近距离放射治疗手术。与15μg芬太尼相比，它提供了足够的麻醉和延长的脊髓镇痛效果。
