E-Science Station

Ischemic heart disease is a common disease and leading cause of death in Thailand. Coronary angiography and angioplasty via radial approach is now a standard recommendation by current guidelines. The common side effects of trans-radial approach include pain and radial spasm which could result in unsuccessful vascular access. There has been no data of topical anesthesia in patients undergoing coronary angiography and/or angioplasty before. So this is to study the effect of topical anesthesia on pain assessed during puncture by using visual analog scale and the effect of topical anesthesia on the incidence of radial spasm.

This is double blinded randomized control study. 120 patients who underwent cardiac catherterization were randomized to receive either topical anesthesia (EMLA®) or placebo applied to the puncture site area 30 minutes before procedure. All patients then receive xylocaine injection according to the standard protocol before puncture radial artery. The primary outcome was pain during radial puncture assessed by using VAS score and the main secondary outcome was the incidence of radial spasm. All patients gave written informed consent before enrolled into the study. The study was registered at clinicaltrail.gov (NCT03501212) and at Thai Clinical Trials Registry (TCTR20180420006).

There were 60 patients in each group. The baseline demographic was comparable in both groups. Patients receiving EMLA reported significantly less pain during radial puncture 3.47+/-0.83 vs. 4.98 +/-1.37 (P<0.001). The radial spasm occurred in 2 patients in EMLA group and 13 patients in placebo group (3.3% vs. 21.7%, P = 0.002). The radial pain post procedure in EMLA group was also significantly less than the placebo group (1.55 VS 2.22, P<0.001). The first attempt radial cannulation success was 90% in EMLA group and 31.7% in placebo group. There has been no observed adverse effect of both EMLA and placebo in any patients.

The use of EMLA® cream before trans-radial coronary angiography and/or angioplasty significantly decrease the pain during procedure and effectively prevent radial spasm. This treatment is simple, non-invasive, inexpensive and safe and should be given to patients undergoing trans-raidal coronary procedures.