(P073) Optimal Epidural Analgesia During Interstitial Brachytherapy for Treatment of Gynecological Cancer

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OncologyOncology Vol 29 No 4_Suppl_1
Volume 29
Issue 4_Suppl_1

Epidural analgesia provides safe and effective pain control in patients undergoing ISBT. Epidural delivery of narcotics with ropivacaine improves pain control and lowers oral and intravenous narcotic requirements without increased risk of adverse effects.

Ashley K. Amsbaugh, MD, Mark J. Amsbaugh, MD, Moataz N. El Ghamry, MD, Brian M. Derhake, MD, MS;  Department of Anesthesiology, Department of Radiation Oncology, University of Louisville

PURPOSE: To determine optimal epidural analgesia for patients receiving interstitial brachytherapy (ISBT) for gynecologic cancer.

MATERIALS AND METHODS: Records of all patients who underwent interstitial brachytherapy (ISBT) at our institution between January 2009 and July 2014 were reviewed. ISBT was delivered over the course of 2 to 3 days, and maximum pain scores (measured on a scale from 1 to 10 points) were recorded every 8 hours. The primary analgesia method was epidural catheter. In addition to epidural anesthetic, patients received “as-needed” medications (intravenous narcotics, oral narcotics, and acetaminophen) from a standard order set. Antiemetics and diphenhydramine were available for nausea and pruritus, respectively. Pain scores and administered medications were collected, and all narcotic medications were converted to intravenous morphine equivalent (IVME). Statistical analysis was performed with SAS (Statistical Analysis System) software (SAS Institute, Cary NC).

RESULTS: Epidural catheters were successfully placed in 71 of 73 patients. Twelve patients received ropivacaine alone, 14 patients received ropivacaine with fentanyl, and 45 patients received ropivacaine with hydromorphone. Patients receiving ropivacaine alone had higher pain scores than patients receiving ropivacaine with fentanyl or ropivacaine with hydromorphone on the morning of day 2 (4.2 vs 1.71 vs 0.6; P = .001), the afternoon of day 2 (4.9 vs 2.5 vs 1.7; P = .005), and the night of day 2 (2.4 vs 2.0 vs 0.6; P < .001). Patients receiving narcotics in their epidural had lower pain scores on the night of placement (P = .050), the morning of day 2 (P < .001), the afternoon of day 2 (P = .002), and the night of day 2 (P < .001). Patients receiving ropivacaine alone used more oral narcotics than those receiving ropivacaine with fentanyl or ropivacaine with hydromorphone on day 3 (5.9 mg vs 3.8 mg vs 2.8 mg IVME) and received more intravenous narcotics on day 1 (5.8 mg vs 0.0 mg vs 0.7 mg IVME; P = .004) and day 2 (20.6 mg vs 4.8 mg vs 1.0 mg IVME; P = .042). There were no differences in antiemetic use on days 1 (P = .146), 2 (P = .266), or 3 (P = .360). There were no differences in diphenhydramine usage on days 1 (P = .829), 2 (P = .678), or 3 (P = .413). No epidural complications occurred.

CONCLUSIONS: Epidural analgesia provides safe and effective pain control in patients undergoing ISBT. Epidural delivery of narcotics with ropivacaine improves pain control and lowers oral and intravenous narcotic requirements without increased risk of adverse effects.

Proceedings of the 97th Annual Meeting of the American Radium Society- americanradiumsociety.org

Articles in this issue

(P005) Ultrasensitive PSA Identifies Patients With Organ-Confined Prostate Cancer Requiring Postop Radiotherapy
(P001) Disparities in the Local Management of Breast Cancer in the United States According to Health Insurance Status
(P002) Predictors of CNS Disease in Metastatic Melanoma: Desmoplastic Subtype Associated With Higher Risk
(P003) Identification of Somatic Mutations Using Fine Needle Aspiration: Correlation With Clinical Outcomes in Patients With Locally Advanced Pancreatic Cancer
(P004) A Retrospective Study to Assess Disparities in the Utilization of Intensity-Modulated Radiotherapy (IMRT) and Proton Therapy (PT) in the Treatment of Prostate Cancer (PCa)
(S001) Tumor Control and Toxicity Outcomes for Head and Neck Cancer Patients Re-Treated With Intensity-Modulated Radiation Therapy (IMRT)-A Fifteen-Year Experience
(S003) Weekly IGRT Volumetric Response Analysis as a Predictive Tool for Locoregional Control in Head and Neck Cancer Radiotherapy 
(S004) Combination of Radiotherapy and Cetuximab for Aggressive, High-Risk Cutaneous Squamous Cell Cancer of the Head and Neck: A Propensity Score Analysis
(S005) Radiotherapy for Carcinoma of the Hypopharynx Over Five Decades: Experience at a Single Institution
(S002) Prognostic Value of Intraradiation Treatment FDG-PET Parameters in Locally Advanced Oropharyngeal Cancer
(P006) The Role of Sequential Imaging in Cervical Cancer Management
(P008) Pretreatment FDG Uptake of Nontarget Lung Tissue Correlates With Symptomatic Pneumonitis Following Stereotactic Ablative Radiotherapy (SABR)
(P009) Monte Carlo Dosimetry Evaluation of Lung Stereotactic Body Radiosurgery
(P010) Stereotactic Body Radiotherapy for Treatment of Adrenal Gland Metastasis: Toxicity, Outcomes, and Patterns of Failure
(P011) Stereotactic Radiosurgery and BRAF Inhibitor Therapy for Melanoma Brain Metastases Is Associated With Increased Risk for Radiation Necrosis
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