Prostate HDR radiation therapy: a comparative study evaluating the effectiveness of pain management with peripheral PCA vs. PCEA.
BACKGROUND
High dose rate (HDR) brachytherapy is considered one of the most advanced treatment technologies currently available for treatment of localized prostate cancer. It gives the advantage of applying higher dose radiation, with greater precision, directly to the tumor while sparing healthy tissue and surrounding organs, thereby resulting in fewer side effects. In this facility, the treatment requires an overnight stay in the hospital, in a supine position, with a perineal template sutured to the perineum to prevent catheter movement or dislodgement.


OBJECTIVE
To compare the effectiveness of pain management for men with prostate cancer being treated with HDR brachytherapy using a peripheral patient controlled analgesia (PCA) or patient controlled epidural analgesia (PCEA).


METHODS
A comparative study was conducted evaluating the effectiveness of two pain management methods for men with prostate cancer receiving HDR brachytherapy. Pain assesments were conducted by scoring pain from the Foley catheter, interstitial catheter (perineal) and back (lumbosacral), using the Brief Pain Inventory Scale.


RESULTS
Patients receiving pain management with the PCEA experienced significantly less pain.


CONCLUSIONS
These finding suggest that use of PCEA with bupivacaine and fentanyl is more effective in managing pain related to HDR brachytherapy for prostate cancer, and results in a positive patient outcome thereby improving patient satisfaction.
The Cancer Center, Hackensack University Medical Center, NJ, USA.
Joan
J
Colella
Suzanne
S
Scrofine
Bernadette
B
Galli
Cynthia
C
Knorr-Mulder
Glen
G
Gejerman
John
J
Scheuch
Vincent
V
Lanteri
Andrew
A
Siegel
Stuart
S
Levey
Richard
R
Watson
Michael
M
Block
Ihor
I
Sawczuk
D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D019985:Benchmarking; D001918:Brachytherapy / Q000009:adverse effects*; D002045:Bupivacaine / Q000627:therapeutic use; D002406:Catheterization, Peripheral / Q000379:methods*; D004359:Drug Therapy, Combination; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D015999:Multivariate Analysis; D009730:Nursing Assessment; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D017749:Total Quality Management; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D005283:Fentanyl; D002045:Bupivacaine