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Introduction <p>Pain management during brachytherapy application for cervical malignancy has evolved over the years; the choice of procedure varies worldwide due to each available option's unique features and limitations. In this study, we explore the benefits and limitations of the paracervical block and assess its value in the contemporary setting.</p> Methods <p>This retrospective study included patients of carcinoma cervix who underwent intracavitary brachytherapy (ICBT) from April 2021 to August 2022 at our institute. The primary objective being assessment of pain (using Numerical Rating Scale (NRS)) during ICBT of carcinoma cervix done under paracervical block. Secondary objectives were determining the difference in procedure time between ICBT done under paracervical block and spinal anaesthesia, difference in doses to organs at risk (OARs) and estimating patient preference for paracervical block for the next sitting of intracavitary brachytherapy.</p> Results <p>One hundred and forty-nine intracavitary brachytherapy insertions in 53 patients were analysed. During the tandem insertion into the uterus, none had severe pain (NRS ≥ 7), while only 11.4% experienced moderate pain (NRS 4–6). Looking at pain during the procedure, only 8.9% experienced severe pain, although 70.9% experienced moderate pain. Four hours post-procedure, none reported moderate or severe pain and only 5.1% experienced mild pain. Paracervical block took a median time of 45&#xa0;min for the entire procedure, while spinal anaesthesia required 65&#xa0;min. Brachytherapy application with Paracervical block was found to be symmetrical. Bladder D2cc dose was significantly lower with paracervical block, and rectum and sigmoid D2cc doses were equivalent to spinal anaesthesia. About 95% of the patients preferred a paracervical block for the subsequent application.</p> Conclusion <p>Paracervical block offered adequate pain control and good intracavitary brachytherapy application. With the additional logistical advantages (lesser workforce requirement, no hospital admission, and patient convenience), paracervical block is valuable and viable as a pain management strategy in the intracavitary brachytherapy applicator insertion for gynaecological malignancies.</p>

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Comparative Analysis of Spinal Anaesthesia Versus Paracervical Block for Analgesia in Intracavitary Brachytherapy of Carcinoma Cervix: A Retrospective Study

  • 期刊论文

  • 发表日期：

    2025年1月6日

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  • Ajay S. Krishnan,
  • Sweety Gupta,
  • RS. Namitha,
  • Shreyosi Mandal,
  • Sumit Singh,
  • R. Lekshmi,
  • Biswajyoti Das,
  • Debanjan Sikdar,
  • Rachit Ahuja,
  • Deepa Joseph,
  • Swati Verma,
  • Manoj Gupta

摘要

Introduction

Pain management during brachytherapy application for cervical malignancy has evolved over the years; the choice of procedure varies worldwide due to each available option's unique features and limitations. In this study, we explore the benefits and limitations of the paracervical block and assess its value in the contemporary setting.

Methods

This retrospective study included patients of carcinoma cervix who underwent intracavitary brachytherapy (ICBT) from April 2021 to August 2022 at our institute. The primary objective being assessment of pain (using Numerical Rating Scale (NRS)) during ICBT of carcinoma cervix done under paracervical block. Secondary objectives were determining the difference in procedure time between ICBT done under paracervical block and spinal anaesthesia, difference in doses to organs at risk (OARs) and estimating patient preference for paracervical block for the next sitting of intracavitary brachytherapy.

Results

One hundred and forty-nine intracavitary brachytherapy insertions in 53 patients were analysed. During the tandem insertion into the uterus, none had severe pain (NRS ≥ 7), while only 11.4% experienced moderate pain (NRS 4–6). Looking at pain during the procedure, only 8.9% experienced severe pain, although 70.9% experienced moderate pain. Four hours post-procedure, none reported moderate or severe pain and only 5.1% experienced mild pain. Paracervical block took a median time of 45 min for the entire procedure, while spinal anaesthesia required 65 min. Brachytherapy application with Paracervical block was found to be symmetrical. Bladder D2cc dose was significantly lower with paracervical block, and rectum and sigmoid D2cc doses were equivalent to spinal anaesthesia. About 95% of the patients preferred a paracervical block for the subsequent application.

Conclusion

Paracervical block offered adequate pain control and good intracavitary brachytherapy application. With the additional logistical advantages (lesser workforce requirement, no hospital admission, and patient convenience), paracervical block is valuable and viable as a pain management strategy in the intracavitary brachytherapy applicator insertion for gynaecological malignancies.