Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy

Alison A. Nielsen, Tehani A. Liyanage, Gary S Leiserowitz, Jyoti Mayadev

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. Material and methods: We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia. Results: In 91% of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53%), followed by delirium (22%). Hospital discharge was delayed, at least by one night, in 26% of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia. Conclusions: Interstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.

Original languageEnglish (US)
Pages (from-to)216-223
Number of pages8
JournalJournal of Contemporary Brachytherapy
Volume9
Issue number3
DOIs
StatePublished - Jun 30 2017

Fingerprint

Obstetrical Anesthesia
Postoperative Nausea and Vomiting
Brachytherapy
Postoperative Pain
Patient-Controlled Analgesia
Narcotics
Hydromorphone
Critical Pathways
Anesthesia
Delirium
Pain Management
Anesthetics
Neoplasms
Hospitalization
Demography

Keywords

  • Anesthesia
  • Gynecology oncology
  • Interstitial brachytherapy
  • Perioperative

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy. / Nielsen, Alison A.; Liyanage, Tehani A.; Leiserowitz, Gary S; Mayadev, Jyoti.

In: Journal of Contemporary Brachytherapy, Vol. 9, No. 3, 30.06.2017, p. 216-223.

Research output: Contribution to journalArticle

Nielsen, Alison A. ; Liyanage, Tehani A. ; Leiserowitz, Gary S ; Mayadev, Jyoti. / Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy. In: Journal of Contemporary Brachytherapy. 2017 ; Vol. 9, No. 3. pp. 216-223.
@article{536eb6a30a6248668d5e4bf90e782d87,
title = "Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy",
abstract = "Purpose: To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. Material and methods: We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia. Results: In 91{\%} of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53{\%}), followed by delirium (22{\%}). Hospital discharge was delayed, at least by one night, in 26{\%} of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia. Conclusions: Interstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.",
keywords = "Anesthesia, Gynecology oncology, Interstitial brachytherapy, Perioperative",
author = "Nielsen, {Alison A.} and Liyanage, {Tehani A.} and Leiserowitz, {Gary S} and Jyoti Mayadev",
year = "2017",
month = "6",
day = "30",
doi = "10.5114/jcb.2017.68767",
language = "English (US)",
volume = "9",
pages = "216--223",
journal = "Journal of Contemporary Brachytherapy",
issn = "1689-832X",
publisher = "Termedia Publishing House Ltd.",
number = "3",

}

TY - JOUR

T1 - Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy

AU - Nielsen, Alison A.

AU - Liyanage, Tehani A.

AU - Leiserowitz, Gary S

AU - Mayadev, Jyoti

PY - 2017/6/30

Y1 - 2017/6/30

N2 - Purpose: To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. Material and methods: We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia. Results: In 91% of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53%), followed by delirium (22%). Hospital discharge was delayed, at least by one night, in 26% of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia. Conclusions: Interstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.

AB - Purpose: To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. Material and methods: We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia. Results: In 91% of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53%), followed by delirium (22%). Hospital discharge was delayed, at least by one night, in 26% of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia. Conclusions: Interstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.

KW - Anesthesia

KW - Gynecology oncology

KW - Interstitial brachytherapy

KW - Perioperative

UR - http://www.scopus.com/inward/record.url?scp=85021732347&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021732347&partnerID=8YFLogxK

U2 - 10.5114/jcb.2017.68767

DO - 10.5114/jcb.2017.68767

M3 - Article

AN - SCOPUS:85021732347

VL - 9

SP - 216

EP - 223

JO - Journal of Contemporary Brachytherapy

JF - Journal of Contemporary Brachytherapy

SN - 1689-832X

IS - 3

ER -