title: Regional intracoronary analgesia during percutaneous transluminal coronary angioplasty.
abstract: The ischemic pain associated with balloon inflation during coronary angioplasty remains a significant source of procedural discomfort and sets a limit on the duration of percutaneous transluminal intravascular interventions. The present study examined whether intracoronary lidocaine reduced the pain of coronary angioplasty. Sixteen patients undergoing elective coronary angioplasty underwent three 90 sec balloon inflations: the first with administration of no intracoronary agent, and the second and third with administration of one or the other of placebo or an equal volume of lidocaine (10-16 mg). Placebo or lidocaine were randomized in administration sequence and were given just before balloon inflation. During the occlusions, pain was scored on an ordinal scale (0 = no pain; 10 = most severe pain). Lidocaine delayed the onset of pain (23 +/- 4 vs. 48 +/- 7 sec, P < 0.005) and reduced its magnitude (at end-inflation: 7.8 +/- 1.3 vs. 3.2 +/- 1.3, P < 0.01). There were no significant hemodynamic or electrophysiologic effects in this group of patients, although atrioventricular conduction was delayed when lidocaine was administered into the epicardial coronary which had the atrioventricular node artery as a branch. Intracoronary analgesia with lidocaine is safe and effective in a select group of patients with normal ventricular function undergoing elective coronary angioplasty.
authors.affiliation: Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD 21205 USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aversano
authors.forename: Gary D
authors.initials: GD
authors.lastname: Walford
authors.forename: Mark
authors.initials: M
authors.lastname: Midei
authors.forename: Paul
authors.initials: P
authors.lastname: Chew
authors.forename: Sidney O
authors.initials: SO
authors.lastname: Gottlieb
authors.forename: Michael N
authors.initials: MN
authors.lastname: Drossner
authors.forename: Harlan
authors.initials: H
authors.lastname: Weisman
authors.forename: James L
authors.initials: JL
authors.lastname: Weiss
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Brinker
mesh_terms: D000368:Aged; D000698:Analgesia; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D003331:Coronary Vessels; D004311:Double-Blind Method; D004452:Echocardiography; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement / Q000187:drug effects
chemical_list: D008012:Lidocaine