புற்றுநோய் மருத்துவ பரிசோதனைகளின் இதழ்

Spinal Analgesia vs. Sedation, Brachytherapy, About 99 Case Reports

Abstract

Yassine Smiti*, Brahim El Ahmadi, Zakaria Belkhadir and Abdelilah Ghannam

The installation of brachytherapy applicator is a painful invasive procedure requiring anesthesia. In this study, we propose to compare intravenous anesthesia with spontaneous ventilation to an intrathecal analgesic protocol with local anesthetics and fentanyl. The main objective was to demonstrate the superiority of spinal analgesia in terms of per and postoperative analgesia during patient mobilization for CT scan. We performed a randomized clinical trial for women patients ASA 1 and 2 programmed for brachytherapy, and then we divided them into 2 groups. Group 1: Have benefited from intravenous anesthesia by propofol titration with fentanyl. Group 2: Benefited from spinal analgesia with bupivacaine 5 mg and fentanyl 25 mg. Then we collected demographic data, quality of anesthesia (Ramsay score for level of sedation, analgesia level by analogical visual scale score), hemodynamic and respiratory parameters, anesthetics events, duration of anesthetic acts, pain during mobilization. The period of our study was 6 months, from January to July 2019. A cohort of 99 patients (group 1=48, group 2=51). The results were similar for the preoperative demographic and medical data (age, Sex,comorbidities,the stage of the disease, chemotherapy and radiotherapy antecedent, surgery antecedent, preoperative pain, preoperative neurological examination). Anesthetic goals were achieved for 100% of the patients in first group and 98% in second group (n=50/51). They were 6 unwanted events in group 1 and 3 in group 2 (p=0.25), but no serious incident were reported, we didn’t achieve any conversion from spinal analgesia to general anesthesia and no drugs were added during the procedure. The induction time was 7.1 ± 2.2 min in group 1 and 12.1 ± 3.2 min in group 2 (p=0.045). The duration of awakening after anesthesia was 9.4 ± 5.8 min in group 1. The total duration of the procedure was 47.4 ± 8.7 min in group 1 versus 49.7 ± 8.4 min in group 2 (p=0.46). After the procedure the evaluation of the pain during mobilization at 5 minutes, 15 minutes and 30 minutes were respectively at 4/10-4/10-6/10 in group 1 and 0/10- 0/10-1/10 in group 2 (p=0.002).