Abstract

JACC

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TCTAP A-086

Application of Emla Cream Prior to Radial Puncture: An Initiative to Improve Patient Experience

By An Shing Ang, Ki Fung Cliff Li, Paul JL Ong, Nur Fatin Nazira Abdul Malek, Nurul Syahiirah Zulkefli Mat Yusuff, Hee Hwa Ho

Presenter

An Shing Ang

Authors

An Shing Ang1, Ki Fung Cliff Li1, Paul JL Ong2, Nur Fatin Nazira Abdul Malek1, Nurul Syahiirah Zulkefli Mat Yusuff1, Hee Hwa Ho1

Affiliation

Tan Tock Seng Hospital, Singapore1, Heart Specialist International, Singapore2
View Study Report
TCTAP A-086
Vascular Access (Transradial)

Application of Emla Cream Prior to Radial Puncture: An Initiative to Improve Patient Experience

An Shing Ang1, Ki Fung Cliff Li1, Paul JL Ong2, Nur Fatin Nazira Abdul Malek1, Nurul Syahiirah Zulkefli Mat Yusuff1, Hee Hwa Ho1

Tan Tock Seng Hospital, Singapore1, Heart Specialist International, Singapore2

Background

The radial approach is standard of care for coronary angiogram as it confers a lower incidence of major vascular access related complications and allows for early mobilization. 
This study aims to evaluate the effectiveness of eutectic mixture of local anesthesia (EMLA) cream in reducing pain as part of an initiative to improve patient experience after radial puncture.

Methods

218 patients booked for elective coronary angiogram were recruited. EMLA cream was applied prior to radial artery puncture. All patients were given subcutaneous lignocaine at the puncture site. We evaluated the mean pain score amongst the whole population. 
Within this population, 71 of them had previous coronary angiograms performed without EMLA application. We compared the degree of radial pain with and without EMLA application in this group of patients. 
Radial pain was measured by the numeric pain rating scale (NPRS).


Results

The mean pain score of the whole study population was 2.48. Majority of patients (83.1%) felt that application of EMLA cream was necessary to improve their experience. 
Analysis of patients who had no EMLA application for previous coronary angiogram showed that radial pain was significantly lower with EMLA application. (NPRS: 4.41 vs 2.57, p= <0.01). Age, gender and the indication of elective coronary angiogram did not significantly affect the reduction in pain score. 
The mean duration of EMLA application prior to radial puncture was 53.1 minutes. The duration was not significantly associated with reduction of radial pain. 
   Pain score before  Pain score after  P value
 Total population (n=71)  4.41  2.57     <0.001
 Male (n = 61)  4.39  2.52  <0.001
 Female (n = 10) 4.50    2.89    <0.001

   Reduction in pain score  P value
GENDERMaleFemale
1.911.50 
 0.551
AGE31-4041-5051-6061-70>70
1.502.602.122.110.89
0.231 
INDICATION FOR CORONARY ANGIOGRAM 
AnginaPositive stress testAbnormal CTCAPre-valvular surgery/pre-renal transplant work upOthers

2.001.911.00-1.002.00
 0.162

Conclusion

Application of the EMLA cream is easy and effective in reducing pain in patients undergoing coronary angiogram via radial approach. This appears to be well received amongst the patients. The reduction in radial pain may help to reduce the sympathetic drive of these patients and possibly reduce incidence of radial artery spasm which can represent a significant challenge to access and reduce procedural success rate.

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