Saddle block analgesia for high-dose-rate brachytherapy: A prospective study.
OBJECTIVE
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 20microg 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.
Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. hance.clarke@utoronto.ca
Hance A
HA
Clarke
Jordan
J
Tarshis
Jenny
J
Lam-McCulloch
Joseph
J
Kay
D000328:Adult; D000762:Anesthesia Recovery Period; D000775:Anesthesia, Spinal; D000777:Anesthetics / Q000008:administration & dosage*; D001918:Brachytherapy; D002045:Bupivacaine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage
D000777:Anesthetics; D002045:Bupivacaine