Optimal epidural analgesia for patients diagnosed as having gynecologic cancer undergoing interstitial brachytherapy

Study objective: To determine the optimal epidural analgesia for patients receiving interstitial brachytherapy (ISBT) for gynecologic cancers.

Design: Retrospective analysis.

Setting: Operating room and hospital ward.

Patients: Seventy-three patients diagnosed as having gynecologic cancer and undergoing ISBT.

Interventions: Twelve patients received ropivacaine alone, 14 patients received ropivacaine with fentanyl, and 45 patients received ropivacaine with hydromorphone by epidural infusion.

Measurements: Numeric Rating Scale pain scores, amounts of nonnarcotic and narcotic pain medications used in intravenous morphine equivalents (IVMEs), and amount of antiemetic or antipruritic medications used.

Main results: Patients receiving ropivacaine alone had higher pain scores 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 opioids 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 did those receiving ropivacaine with fentanyl or ropivacaine with hydromorphone on day 3 (5.9 vs 3.8 vs 2.8mg IVME) and received more intravenous opioids day 1 (5.8 vs 0.0 vs 0.7mg IVME, P=.004) and day 2 (20.6 vs 4.8 vs 1.0mg IVME, P=.042). There were no differences in antiemetic or diphenhydramine usage at any time point. No epidural complications occurred.

Conclusions: For patients receiving ISBT for gynecologic cancer, epidural analgesia provides safe and effective pain control. Combined modality epidural analgesia improves pain control and lessens oral and intravenous opioid requirements without increased risk of adverse effects compared with epidural analgesia with local anesthetic alone.