Spinal anaesthesia for brachytherapy for carcinoma of the cervix: a comparison of two dose regimens of hyperbaric bupivacaine

Abstract

Objectives : Spinal anaesthesia can be suitably performed for a variety of day-stay (ambulatory) surgical procedures. The time taken for adequate recovery to allow discharge home from hospital is an important consideration. The purpose of this study was to compare the suitability of two different doses of hyperbaric bupivacaine for spinal anaesthesia for day-stay brachytherapy for carcinoma of the cervix. Design: This was a prospective, randomised, double-blind study. Setting and subjects: Forty female patients, presenting to Groote Schuur Hospital for brachytherapy for carcinoma of the cervix, were randomised to receive either 5 mg or 9 mg (1 ml or 1.8 ml) of 0.5% hyperbaric bupivacaine, plus 15 μg fentanyl via the L3/L4 interspace. Results : Patients receiving the lower dose could be discharged from the recovery room in a shorter time (p-value < 0.01). The time taken to achieve hospital discharge criteria was significantly shorter in the group receiving the lower dose [a mean time of 235 (206-264) vs. 280 (263-297) minutes, p-value < 0.01]. There was significantly less motor block in the low-dose group (p-value < 0.001). Patient satisfaction regarding motor block was similar in the two groups (p-value = 0.96). There was a trend towards a higher number of inadequate spinal blocks in the low-dose group (p-value = 0.34). Conclusion: Our study suggests that a dose that is closer or equivalent to that of the high-dose group (9 mg bupivacaine plus 15 μg fentanyl) is preferable for brachytherapy for carcinoma of the cervix in ensuring consistent and reliable spinal anaesthesia in this patient population. Keywords: spinal, anaesthesia, bupivacaine, brachytherapy, ambulatory, day case