Background:Prostatic brachytherapy presents the Anaesthesiologist with unique problems1. The aim of this report is to describe our anaesthetic approach to a patient with a recidivated prostatic cancer that needed to be awake and immobilized for more than 12 hours, to be submitted to 2 sessions in the same day.Case Report:79-year-old patient, with past medical history of ischemic cardiac disease, hypertension and radiotherapy for prostatic cancer in 2009, with recent recurrence, was proposed for brachytherapy in 2 sessions spaced 12 hours apart. Preoperative exams were normal. Clopidogrel and aspirin were suspended and thromboembolism prophylaxis was secured. Patient was monitored by ASA standards and a combined spinal-epidural at L3 level was performed with bupivacaine (10mg) and sufentanyl (2,5ug) uneventfully. Anxiety was managed with midazolam iv. The first session of brachytherapy lasted 3 hours and involved insertion of needles in the prostatic tissue, confirmation of correct placement in CT room and radiation treatment. Needles remained in place and the patient was sent to the recovery room with an epidural perfusion for analgesia and immobilization. Epidural block and pain were assessed hourly and nurse-care provided with lumbar-sacral massages. 12 hours later, the second session was executed. At the end, perineal needles were withdrawn and epidural catheter was removed. The day after, patient was discharged home.Discussion:Regional techniques are the leading anaesthetic approach to pelvic brachytherapy1,2,3 but there aren’t any specific publications about the ideal anaesthesia for 2-fraction prostatic brachytherapy. Analgesia, immobilization and even monitoring and transport between radiotherapy, CT and recovery rooms are main concerns. Based on our experience, we suggest the portrayed technique as an appropriate option for this procedure. Learning points:2-fraction prostatic brachytherapy presents the Anaesthesiologist with additional concerns, namely analgesia, immobilization, monitoring and transport. Combined spinal-epidural anaesthesia with an epidural infusion seems an appropriate option.

References: 1.Analgesia for pelvic brachytherapy; Smith et al; BJA 2002; 88(2):270-6 
2.Anaesthesia for brachytherapy - 5 1⁄2 yr of experience in 1622 procedures; Benrath et al; BJA 2006; 96(2):195–200 3.Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy; Nielsen et al; JContemp Brachytherapy 2017; 9(3):216-223

02 / Anaesthesia for 2-fraction prostatic brachytherapy – a case report