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Intra-arterial lidocaine versus saline to reduce peri-procedural discomfort in patients undergoing percutaneous trans-radial or trans-ulnar coronary procedures.

Author(s): Biondi-Zoccai GG, Moretti C, Omede P, Sciuto F, Agostoni P, Romagnoli E, Sangiorgi G, Sheiban I

Affiliation(s): Division of Cardiology, University of Turin, San Giovanni Battista Molinette Hospital, Turin, Italy. gbiondizoccai@gmail.com

Publication date & source: 2011-02, Acta Cardiol., 66(1):9-14.

Publication type: Comparative Study; Randomized Controlled Trial

OBJECTIVE: Trans-radial and trans-ulnar access is increasingly used for percutaneous coronary procedures, but spasm or pain may limit comfort and compliance. Intra-arterial lidocaine administration could provide a local anaesthetic effect, but its risk-benefit ratio is unclear. We aimed to compare intraarterial lidocaine versus saline to reduce peri-procedural discomfort during percutaneous trans-radial or trans-ulnar procedures. METHODS AND RESULTS: Patients undergoing percutaneous trans-radial or trans-ulnar coronary procedures were single-blinded randomly assigned to intra-arterial treatment with 20 mg lidocaine or saline. The primary end-point of the study was local pain, measured on a 10-point scale. A total of 101 patients were enrolled (50 allocated to lidocaine and 51 to saline). Trans-radial access was employed in 48 (96%) and 47 (92%), respectively, trans-ulnar access in 2 (4%) and 4 (8%), and coronary intervention was performed in 18(36%) and 11 (22%). Severity of local pain was equivalent in both groups (2.3 +/- 2.3 vs. 3.0 +/- 2.5, P= 0.167). Similar results for both groups were found also for local spasm, local access success, procedural success, and net clinical adverse events (all P > 0.05). No sustained cardiac arrhythmia or neurologic symptom developed in any patient. CONCLUSIONS: Current approaches and techniques for percutaneous trans-radial or trans-ulnar coronary procedures are associated with few local or systemic complications. Local forearm/wrist pain is relatively frequent in this setting, and is not significantly prevented by intra-arterial lidocaine.

Page last updated: 2011-12-09

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