Patterns Of Anaesthesia(As) And Analgesia(Ag) Practice In Gynecological Brachytherapy: The Indian Scenario

INTRODUCTIONFractionated HDR brachytherapy, following external beam radiotherapy, is essential for treating locally advanced cervical cancer. Modern techniques enable delivering multiple fractions with a single application. However, applicator insertion, duration of it in situ and removal causes significant pain and distress. With no standardized guidelines for anesthesia in gynecological brachytherapy, this study surveyed current practices of anesthesia used across India to better understand and improve these issues. MATERIALS AND METHODSA survey was conducted with an online questionnaire that was shared with radiation oncologists through social media platforms (survey instrument: Rivera et al 2024). Analysis was done using descriptive statistics. RESULTS93 responses were received, excluding 14 repeats 79 responses were analysed. Most of the respondents were male (52%). The most common place for intracavitary application is a dedicated brachytherapy suite. Spinal anesthesia, alone or in combination, was the most frequently used technique for intracavitary (39%), hybrid (30%), and interstitial (36%) brachytherapy. Most institutes are doing >20 applications per month. During waiting periods and treatments, oral analgesia is most commonly used. Nearly half (49%) of respondents perceived the procedure as distressing, yet fewer than half (44%) reported implementing measures to reduce psychological distress. Compared with Western data, Indian practice is characterized by higher procedure volumes, greater reliance on regional anesthesia, and limited use of conscious sedation. CONCLUSIONWe observed clinician preference for using the type of AG which highlights the Clinician bias in pain control in gynaecological brachytherapy. AG/AS during waiting times and applicator removal are areas of interest and shall be explored more. There is a need for good evidence for better management of pain and distress associated with gynaecological brachytherapy.