Comparison of spinal and general anesthesia approaches for MRI-guided brachytherapy for cervical cancer

PURPOSE: To evaluate the impact of general versus spinal anesthesia on postprocedure narcotic use and of extradepartmental planning MRI on treatment time in high-dose-rate brachytherapy for cervical cancer. METHODS AND MATERIALS: Twenty-five patients (10 general anesthesia and 15 spinal anesthesia) who collectively received 96 brachytherapy fractions (39 general and 57 spinal) for cervical cancer between February 2015 and April 2017 were retrospectively reviewed. Over this time, institutional practice shifted from operating room based general anesthesia to intradepartmental spinal anesthesia for tandem and ring placement. In some cases, extradepartmental planning MRI was performed. Administrations of narcotics after tandem and ring placement were recorded, and dosages were converted to intravenous (IV) morphine equivalents. Total treatment times for fractions using spinal anesthesia were documented. RESULTS: The general anesthesia group included a significantly higher proportion of fractions using postprocedure narcotics (100.0% vs. 31.6%, p < 0.0001). The general and spinal anesthesia groups required an average of 16.9 mg (range: 2.0-59.2) and 1.4 mg (range: 0.0-17.5) IV morphine equivalents per fraction, respectively (p < 0.0001). When using spinal anesthesia, the average total treatment time with MRI was 311.0 min (range: 218-379) versus 306.6 min (range: 177-429) without MRI (p = 0.810). CONCLUSION: Intradepartmental spinal anesthesia results in significant decreases in postprocedure narcotic usage compared with operating room based general anesthesia. When using spinal anesthesia, addition of extradepartmental MRI does not increase treatment time. This workflow avoids transporting patients under general anesthesia, minimizes the need for MRI-compatible monitoring, allows treatment of multiple patients per day, and provides adequate analgesia. (C) 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.